第三腓骨肌动力解剖重建外侧副韧带  

Dynamic anatomic reconstruction of lateral collateral ligament with peroneus tertius

作　　者：马富强[1] 王翔宇[1] 徐俊峰[1] 尚林[1] 贾光辉[1] 李琦[1] 张小龙 王亚磊[1] 孙士强[1] MA Fu-qiang;WANG Xiang-yu;XU Jun-feng;SHANG Lin;JIA Guang-hui;LI Qi;ZHANG Xiao-long;WANG Ya-lei;SUN Shi-qiang(Department of Foot and Ankle Surgery, Zhengzhou Orthopedics Hospital, Zhengzhou 450000,China)

机构地区：[1]郑州市骨科医院足踝外科,河南郑州450000

出　　处：《中国矫形外科杂志》2019年第10期934-937,共4页Orthopedic Journal of China

基　　金：河南省医学科技公关项目(编号:201503237)

摘　　要：[目的]介绍第三腓骨肌腱解剖重建外侧副韧带治疗踝关节慢性外侧不稳定的技术与临床疗效。[方法]回顾分析2015年12月～2018年01月采用第三腓骨肌动力解剖重建外侧副韧带治疗慢性踝关节外侧不稳63例。在第三腓骨肌肌腱远端止点处切断,向近端游离至远侧伸肌支持带近端,向下牵拉肌腱,于距骨颈距腓前韧带附着点放置锚钉,缝合固定第三腓骨肌腱。于外踝距腓前韧带及跟腓韧带附着点分别建立骨道并相通,将移植腱游离端穿过骨隧道,拉紧肌腱,Swivelock锚钉固定肌腱,重建距腓前韧带,再在跟骨止点建立骨道,将移植腱游离端导入,Swivelock锚钉固定,重建跟腓前韧带。[结果]随访时间为8～28个月。术后6个月,患者的AOFAS评分,应力下影像距骨倾斜角、距骨前移距离均较术前显著改善,差异均具有统计学意义(P<0.05)。末次随访时,临床结果评定为优11例,良49例,可3例,优良率为95.24%。[结论]应用第三腓骨肌解剖重建外侧副韧带,创伤小,操作简单,临床疗效满意。[Objective] To introduce the operative technique and primary clinical outcomes of dynamic anatomic reconstruction of lateral collateral ligament with peroneus tertius for chronic ankle lateral instability.[Methods] From December 2015 to January 2018, 63 patients with chronic lateral ankle instability were surgically treated with dynamic anatomic recon - struction of lateral collateral ligament of ankle by peroneus tertius in our department. The peroneus tertius tendon was detached from its distal insertion, freed reversely to the distal edge of extensor retinaculum, and secured the tendon without disconnection on the talus insertion of anterior talofibular ligament (ATFL) with an anchor suture under proper tension. After that, a curved bone tunnel was created and communicated from insertion of ATFL and calcaneofibular ligament (CFL) on the lateral malleolus. The tendon graft was passed through the tunnel, tightened and secured with interference screw to reconstruct ATFL. Finally, the free end of the graft was fastened into the bone tunnel with a swivelock anchor on the calcaneus at anatomic insertion of CFL to reconstruct the CFL.[Results] The patients were followed up for 8~28 months. At 6 months after operation, the AOFAS score, talus tilt and the distance of talus anterior displacement under stress measured on images statistically significantly improved in all the patients compared with those before operation (P<O.05). At the latest follow up, the clinical outcomes were graded as excellent in 11 cases, good in 49 cases and fair in 3 cases, with the excellent and good rate of 95.2%.[Conclusion] This dynamic anatomical reconstruction of lateral collateral ligament with peroneus tertius for chronic ankle lateral instability does achieve satisfactory primary clinical outcomes with advantages of minimized trauma and simplified surgical operation.

关 键 词：第三腓骨肌 慢性踝关节不稳 解剖重建 距腓前韧带 

分 类 号：R687[医药卫生—骨科学]