部分腓骨短肌腱联合双intra-fix挤压螺钉固定解剖重建距腓前韧带  

Anatomical reconstruction of anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws

作　　者：王震宇 郑果 郑小龙 谢兴宇 陶旭 唐康来 WANG Zhenyu;ZHENG Guo;ZHENG Xiaolong;XIE Xingyu;TAO Xu;TANG Kanglai(Sports Medicine Center,the First Affiliated Hospital of Army Medical University,Chongqing,400038,P.R.China;Unit 95979 of People’s Liberation Army of China,Xintai Shandong,271000,P.R.China)

机构地区：[1]陆军军医大学第一附属医院运动医学中心,重庆400038 [2]中国人民解放军95979部队,山东新泰271000

出　　处：《中国修复重建外科杂志》2021年第1期70-75,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81572133)。

摘　　要：目的探讨部分腓骨短肌腱联合双intra-fix挤压螺钉固定解剖重建距腓前韧带的疗效。方法回顾分析2015年9月—2019年10月收治且符合选择标准的46例距腓前韧带断裂患者临床资料,均采用部分腓骨短肌腱联合双intra-fix挤压螺钉固定解剖重建距腓前韧带。男22例,女24例;年龄16~52岁,平均28.1岁。40例存在踝关节扭伤史,1例重物砸伤,5例摔伤。左侧17例,右侧29例。病程3个月~10年,中位病程20.3个月。记录患者手术前后踝关节疼痛视觉模拟评分(VAS)、美国矫形足踝协会(AOFAS)踝-后足评分、踝关节内翻角度、健患侧距骨前移差异(松弛、相似、紧张);其中23例患者增加自评预后测量系统(PROMIS)评分,包括疼痛影响力(pain interference,PI)、物理功能(physical function,PF)评分。结果手术时间39~179 min,平均65.8 min。术后切口均Ⅰ期愈合。患者均获随访,随访时间12~30个月,平均23个月。术后6个月及末次随访时VAS评分、AOFAS踝-后足评分、PROMIS的PI及PF评分、健患侧距骨前移差异、踝关节内翻角度均较术前明显改善,差异有统计学意义(P<0.05);术后6个月与末次随访时VAS评分、PROMIS的PI评分、AOFAS踝-后足评分差异均无统计学意义(P>0.05),但PROMIS的PF评分、健患侧距骨前移差异、踝关节内翻角度差异有统计学意义(P<0.05)。结论部分腓骨短肌腱联合双intra-fix挤压螺钉固定解剖重建距腓前韧带具有切口小、取腱便捷、移植物固定牢固等优点,术后患者恢复快,临床疗效满意。Objective To investigate the effectiveness of anatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws.Methods A clinical data of 46 patients with the anterior talofibular ligament rupture admitted between September 2015 and October 2019 and met the selection criteria were retrospectively analyzed.All anterior talofibular ligaments were reconstructed with partial peroneal brevis tendon and fixed with double intra-fix screws.There were 22 males and 24 females,with an average age of 28.1 years(range,16-52 years).Forty cases had a history of ankle sprain,1 case was injured by a heavy object,and 5 cases were suffered from falls.There were 17 cases on the left side and 29 cases on the right side.The disease duration ranged from 3 months to 10 years(median,20.3 months).The visual analogue scale(VAS)score,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,varus angle of ankle,and the difference of the anterior talar translation between healthy and affected sides(looseness,similarity,tightness)were recorded before and after operation;23 patients were evaluated by Patient-Reported Outcomes Measurement Information System(PROMIS)score,including pain interference(PI)and physical function(PF)scores.Results The operation time was 39-179 minutes,with an average of 65.8 minutes.All incisions healed by first intention.All patients were followed up 12-30 months(mean,23 months).The VAS score,AOFAS ankle-hindfoot score,varus angle of ankle,difference of the anterior talar translation between healthy and affected sides,and PI and PF scores of PROMIS at 6 months and last follow-up significantly improved when compared with those before operation(P<0.05).There was no significant difference in VAS score,PI score of PROMIS,and AOFAS ankle-hindfoot score between at 6 months and at last follow-up(P>0.05).However,the PF score of PROMIS,the difference of the anterior talar translation between healthy and affected sides,and the varus angle of ankl

关 键 词：距腓前韧带 腓骨短肌腱 解剖重建 微创 

分 类 号：R687.4[医药卫生—骨科学]