腓骨短肌腱Ⅴ双束解剖重建距腓前韧带  

V-shaped double-bundle anatomical reconstruction of the anterior talofibular ligament by using a half peroneal brevis ten⁃don

作　　者：韩海元 张永超 曲新强 崔东云 郝佳杰 季晓峰 孙健 HAN Hai-yuan;ZHANG Yong-chao;QU Xin-qiang;CUI Dong-yun;HAO Jia-jie;JI Xiao-feng;SUN Jian(Department of Orthopae-dics,The 80 th Army Hospital of PLA,Weifang 261021,China)

机构地区：[1]陆军第八十集团军医院骨科,山东潍坊261021

出　　处：《中国矫形外科杂志》2023年第8期734-737,共4页Orthopedic Journal of China

基　　金：潍坊市科技发展计划项目(编号:2020YX094)。

摘　　要：[目的]介绍腓骨短肌腱“Ⅴ”双束解剖重建距腓前韧带(anterior talofibular ligament, ATFL)的手术技术和初步临床效果。[方法]对23例ATFL断裂的患者取自体部分腓骨短肌腱“Ⅴ”双束重建距腓前韧带,以ATFL走行为中心作弧形切口,暴露ATFL,确认残余韧带组织无法直接缝合。分别于ATFL腓骨解剖止点印迹的上缘和下缘,以及距骨解剖止点印迹片建立3处骨隧道。用取腱器纵向切取一半的腓骨短肌腱,制备Ⅴ形移植物。将移植物分别引入相应骨隧道,拉紧,用挤压螺钉或锚钉固定,完成双束Ⅴ形ATFL重建。[结果]所有患者均顺利完成手术,无严重并发症,随访12个月以上。AOFAS评分由术前的(46.7±9.5)分显著提高至术后12个月(91.6±2.8)分(P<0.05),KAF评分由术前的(49.4±1.9)分显著提高至术后12个月(90.8±2.7)分(P<0.05),ⅤAS疼痛评分由术前的(5.8±0.9)分显著减少至术后12个月(1.7±0.9)分(P<0.05)。末次随访时,23例患者ADT及TTT均为阴性,踝关节疼痛、日常功能和关节活动、稳定性及后足对线较术前均有明显改善。[结论]腓骨短肌腱“Ⅴ”双束解剖重建ATFL,可更好地恢复踝关节生物力学功能,临床疗效肯定。[Objective]To introduce the surgical technique and preliminary clinical results of V-shaped double-bundle anatomical re⁃construction of the anterior talofibular ligament(ATFL)by using a half peroneal brevis tendon.[Methods]A total of 23 patients received abovementioned surgical treatment for chronic lateral ankle instability.Over the ATFL trace an arc incision was made to expose the liga⁃ment remnants,which proved unproper to be sutured directly.The bone tunnels were created individually on the upper and lower border of the anatomic fibular footprint,as well as the talar anatomic footprint.A longitudinal half peroneus brevis tendon was obtained by a tendon harvester,and prepared to V-shaped graft.Subsequently,the tendon graft was respectively introduced into the superior fibular tunnel,the inferior fibular tunnel and the talar tunnel,and tighten and fixed with interference screws or suture anchors to reconstruct the ATFL in dou⁃ble bundles and V-shape.[Results]All patients were successfully operated on without serious complications,and were followed up for more than 12 months.The AOFAS score significantly increased from(46.7±9.5)before operation to(91.6±2.8)12 months after operation(P<0.05),KAF score significantly increased from(49.4±1.9)to(90.8±2.7)(P<0.05),whereas the VAS pain score significantly decreased from(5.8±0.9)before surgery to(1.7±0.9)12 months after surgery(P<0.05).At the latest follow-up,all the patients got negative ADT and TTT tests,had no ankle pain,and got considerably improved daily function and joint movement,stability and hindfoot alignment compared with those preoperatively.[Conclusion]This V-shaped double-bundle ATFL anatomical reconstruction with longitudinal half peroneus brevis tendon dose restore the biomechanical function of the ankle and achieve sound clinical outcome.

关 键 词：踝关节外侧慢性不稳 腓骨短肌腱 距腓前韧带 解剖重建 

分 类 号：R687[医药卫生—骨科学]