全关节镜下距腓前韧带解剖重建治疗慢性踝关节不稳定的疗效观察  

All-inside Arthroscopic Anterior Talofibular Ligament Anatomic Reconstruction for Chronic Ankle Instability

作　　者：魏世隽[1] 蔡贤华[1] 黄继锋[1] 徐峰[1] 刘曦明[1] 齐凤宇[1] 兰生辉[1] 汤明[1] 陈家[1] 孔长旺[1] 吴刚[1] WEI Shi-jun CAI Xian-hua HUANG Ji- feng XU Feng L IU Xi-ming QI Feng-yu LAN Sheng-hui TANG Ming CHEN Jia KONG Chang-wang WU Gang(Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Wuhan Hubei 430070, Chin)

机构地区：[1]广州军区武汉总医院骨科,湖北武汉430070

出　　处：《华南国防医学杂志》2016年第9期566-570,共5页Military Medical Journal of South China

基　　金：武汉市中青年医学骨干人才培养计划资助项目([2014]77号)

摘　　要：目的探讨全关节镜下自体股薄肌腱解剖重建距腓前韧带（anterior talofibular ligament,ATFL）治疗慢性踝关节不稳定的方法及临床疗效。方法将作者医院2015-12/2016-04月收治的9例慢性踝关节不稳定患者纳入研究,其中男性8例,女性1例,年龄20~43岁,平均32.3岁;术前踝关节应力位片提示距骨倾斜平均14.3°（13~19°）,关节镜下探查清理,经踝关节镜前外侧入口观察,前外侧辅助入口于腓骨远端和距骨颈外侧面ATFL足印区制作骨隧道,取自体股薄肌腱经骨隧道解剖重建ATFL,5.0mm×15 mm界面螺钉固定,术后功能支具固定踝关节于中立位,早期功能锻炼,术后6周在护踝保护下行走,末次随访采用美国足踝外科学会（American Orthopedic Foot and Ankle Society,AOFAS）评分标准及视觉模拟评分（visual analogue scale,VAS）评估疗效。结果术后随访3~9个月（平均4.9个月）,无患者感染及切口延迟愈合,9例患者均于术后3个月恢复体育活动;至末次随访时未观察到踝关节不稳定征象,AOFAS评分平均89.4分（85~96分）,VAS评分平均1.4分（1~4分）。结论全关节镜下自体股薄肌肌腱解剖重建ATFL治疗慢性踝关节不稳定,初期疗效理想。Objective To evaluate the surgical technique and preliminary clinical outcome of all-inside arthroscopic anterior talofibular ligament（ATFL）anatomic reconstruction with a gracilis tendon autograft for chronic ankle instability.Methods In the period of December 2015 to April 2016,9 consecutive patients（8 male and 1femal,age from20-43 years old,mean age was 32.3 years old）with chronic ankle instability were treated in authors＇ hospital.All patients were evaluated preoperatively with stress X-rays,the mean of talar tilt angle was 14.3°（13-19°）.The arthroscopy was introduced through the anterolateral portal,and under direct arthroscopic visualization,drilled tunnels in the fibula and talus by 4.5mm cannulated drill.The gracilis tendon autograft was passed through tunnels with a suture passer and secured by an5.0mm×15 mm interference screw.After the operation,the ankle joint was fixed by plaster or brace in neutral position with early functional exercise.Full weightbearing with orthosis started in6 weeks postoperatively.Functional evaluation carried out according to the hind-foot score by American Orthopedic Foot and Ankle Society（AOFAS）and visual analogue scale（VAS）score.Complications were recorded.Results Nine patients were followed up with a mean duration of 4.9 months（3 to 9 months）.No complications of wound infection or delayed wound healing were noted.No patients experienced any recurrent episodes of ankle instability.According to AOFAS scores and VAS scores,the mean of AOFAS was 89.4（85-96）,the mean of VAS was 1.4（1-4）.Conclusion All-inside arthroscopic ATFL anatomic reconstruction with a gracilis tendon autograft is an effective treatment for chronic ankle instability.

关 键 词：慢性踝关节不稳定 距腓前韧带 解剖重建 关节镜 

分 类 号：R684.7[医药卫生—骨科学]