改良腓骨短肌腱转位治疗慢性踝关节外侧不稳的中-短期疗效观察  

The mid-and short-term effects of modified peroneus brevis tendon transposition for treatment of chronic lateral ankle instability

作　　者：张言[1] 梁晓军[1] 李毅[1] 赵宏谋[1] 梁景棋 

机构地区：[1]西安交通大学附属红会医院足踝外科,710054

出　　处：《美中国际创伤杂志》2017年第4期21-24,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的：探究改良腓骨短肌腱转位治疗慢性踝关节外侧不稳的手术方法和中短期疗效。方法：对自2012年4月至2014年9月收治的27例（共27足）慢性踝关节外侧不稳的患者资料进行回顾性分析，男11例，女16例；年龄19～49岁，平均31．3岁。受伤至手术时间6个月至13年，平均22．8个月。其中初次手术24例，2次手术3例。所有患者均在手术中将腓骨短肌腱转位方法给予改良后界面钉固定。术后定期随访，记录踝关节活动度、距骨倾斜角及相关并发症，并比较术前与末次随访时患者的距骨倾斜角、美国骨科足踝外科协会（AOFAS）踝与后足评分、正常行走时的疼痛视觉模拟评分（VAS）以及踝关节外侧副韧带损伤Karlsson评分。结果：所有患者术后获15～40个月（平均27．3个月）随访。随访中1例患者手术切口出现浅表感染，延迟愈合；2例患者出现患足外侧皮肤麻木，经口服药物治疗均于术后3个月症状消失。所有患者均未出现踝关节外侧不稳复发。至末次随访时，距骨倾斜角由术前（15．4±2．7）°改善为术后（4．6±0．8）°，患者AOFAS踝关节评分由术前（55．8±8．0）分改善为（85．4±4．7）分，VAS评分由术前（5．3±1．0）分降低为（1．3±0．6）分，Karlsson评分由术前（46．1±9．6）分改善为（81．4±8．8）分，各组数据差异有统计学意义（P〈0．05）。患足术后1年的踝关节活动度与术后3．6个月比较有改善，差异有统计学意义（P〈0．05）。患足术后1年及以后随访的踝关节活动度与健足比较差异无统计学意义（P〉0．05）。结论：改良腓骨短肌腱转位治疗慢性踝关节外侧不稳中短期疗效满意，术后踝关节活动受限经过康复锻炼可恢复良好，值得在临床推广。Objective： To explore the mid- and short-term effects of modified peroneus brevis tendon transposition for treatment of the chronic lateral ankle instability. Methods： The data of 27 patients （27 feet） with unstable chronic lateral ankle instability from April 2012 to September 2014 were retrospectively analyzed, including 11 male and 16 female, aged 19-49 years old, with an average age of 31.3 years old. The time from injury to surgery was 6 months to 13 years （mean 22.8 months）. All patients were treated with modified peroneus brevis tendon transposition. Regular follow-up was carried out after operation, ROM （range of motion） of ankle joint, talar tilt angle, related complications, AOFAS ankle and hindfoot score, VAS score on normal walking and Karlsson ankle functional score were recorded and compared between pre-operation and the final follow-up visit. Results： All patients were followed up for 15-40 months （mean 27.3 months）. One patient appeared superficial infection on the incision wound and delayed healing, two patients suffered from lateral skin numbness of foot and the symptoms disappeared in 3 months after taking oral medicine. No recurrence of the lateral ankle instability happed. At the end of the final follow-up visit, talar tilt angle was improved from （15.4±2.7）° to （4.6±0.8）°, AOFAS ankle and hindfoot score was improved from （55.8±8.0）° to （85.4±4.7）°, VAS score was improved from （5.3±1.0）° to （1.3±0.6）°, Karlsson seore was improved from （46.1±9.6）° to （81.4±8.8）°, with a significant difference （P〈0.05）. There was a signifieant difference in ROM of ankle joint between 3.6 months and 1 year after operation （P〈0.05）, but no any significant difference in the follow-up results between affected foot and normal foot 1 year later （P〉0.05）. Conclusion： The mid- and short-term effects of modified peroneus brevis tendon transposition for treatment of the patients with chronic lateral ankle instability can get a satis

关 键 词：踝关节韧带损伤 腓骨短肌 肌腱转位 重建 

分 类 号：R684[医药卫生—骨科学]