微创解剖重建踝关节外侧韧带复合体治疗严重踝关节外侧不稳的中期疗效  

Mid-term efficacy of minimally invasive anatomical reconstruction of lateral ankle ligament complex in the treatment of severe lateral ankle instability

作　　者：区永亮[1] 黄华扬[1] 张涛[1] 李凭跃[1] 沈洪园[1] 王庆[1] 孔令闯 涂强[1] OU Yongliang;HUANG Huayang;ZHANG Tao;LI Pingyue;SHEN Hongyuan;WANG Qing;KONG Lingchuang;TU Qiang(Hospital of Orthopaedics,Guangzhou General Hospital of Guangzhou Military Command,Institute of Traumatic Orthopaedics of PLA,Guangzhou,Guangdong 510010,China)

机构地区：[1]广州军区广州总医院骨科医院全军创伤骨科研究所,510010

出　　处：《中国骨科临床与基础研究杂志》2018年第2期75-79,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省科技计划项目(2014A020212258);广州市科技计划项目(201707010015)

摘　　要：目的探讨微创解剖重建踝关节外侧韧带复合体治疗严重踝关节外侧不稳的中期疗效及安全性。方法回顾性分析2010年1月至2014年12月广州军区广州总医院收治的36例严重踝关节外侧不稳患者的临床资料,患者均行自体半腱肌腱带线锚钉微创重建踝关节外侧韧带复合体手术,记录手术时间和术中出血量,根据美国矫形外科足踝协会(AOFAS)踝-后足功能评分评估术后恢复情况。结果手术时间30~45 min,平均手术时间(38±5)min;术中出血量2~4 m L,平均出血量(2±1)m L。获随访患者35例,随访时间36~60个月,平均随访时间(45.0±6.8)个月。随访期间未出现复发性踝关节不稳、胫距关节炎、距下关节炎并发症。末次随访AOFAS踝-后足功能评分(90.3±6.4)分,明显高于术前(54.3±5.6)分(P<0.05);踝关节功能评定:优24例、良7例、可3例、差1例,优良率89%。结论微创解剖重建踝关节外侧韧带复合体治疗严重踝关节外侧不稳操作简单,创伤小,中期疗效确切。Objective To investigate the safety and mid-term therapeutic effects of minimally invasive anatomical reconstruction of the lateral ankle ligament complex for the treatment of severe lateral ankle instability（LAI）. Methods A total of 36 patients with severe LAI were treated by minimally invasive anatomical reconstruction of the lateral ankle ligament complex using autologous semitendinosus tendons and suture anchor from January 2010 to December 2014 in Guangzhou General Hospital of Guangzhou Military Command and their clinical data were retrospectively analyzed. Operation time and intraoperative estimate blood loss were recorded, and the postoperative function recovery was accessed by ankle-hindfoot function score of American Orthopaedic Foot Ankle Society（AOFAS）. Results Operation time was 30 to 45 min, with the average of（38± 5） min;Intraoperative estimate blood loss was 2 to 4 m L, with the average of（2 ± 1） m L. Thirty-five patients were followed up for 36 to 60 months, with the average of（45.0 ± 6.8） months. No complications of recurrent ankle instability, tibiotalar or subtalar arthritis were found. At the last follow-up, the average ankle-hindfoot function score of AOFAS was（90.3 ± 6.4） points, significantly higher than the preoperative ones,（54.3 ± 5.6）points（P〈 0.05）; ankle function evaluation showed the excellent and good rate of 89%（excellent in 24, good in7, fair in 3 and poor in 1）. Conclusion Minimally invasive anatomical reconstruction of the lateral ligament complex for patients with severe LAI has the advantages of simple procedure, less injury and definite mid-term efficacy.

关 键 词：踝损伤 关节不稳定性 外侧韧带 踝 修复外科手术 外科手术 微创性 带线锚钉 半腱肌腱 

分 类 号：R684.77[医药卫生—骨科学] R687.2[医药卫生—外科学]