自体半腱肌重建跟骰韧带和跟舟韧带治疗慢性分歧韧带损伤的疗效分析  

Reconstruction of the calcaneocuboid and calcaneonavicular ligaments with the autologous semitendinosus in patients with chronic bifurcate ligament injury

作　　者：方真华 于葳葳 赵晶晶 郝铖 谢威 郭井泉 林世伟 富珂 Fang Zhenghua;Yu Weiwei;Zhao Jingjing;Hao Cheng;Xie Wei;Guo Jingquan;Lin Shiwei;Fu Ke(Department of Foot and Ankle Surgery,The Fourth Hospital of Wuhan,Wuhan 430030,China)

机构地区：[1]武汉市第四医院足踝外科,武汉430030

出　　处：《中华创伤骨科杂志》2023年第7期570-575,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨自体半腱肌重建跟骰韧带和跟舟韧带治疗慢性分歧韧带损伤的疗效。方法回顾性分析2018年3月至2021年1月武汉市第四医院足踝外科收治的采用自体半腱肌重建跟骰韧带和跟舟韧带治疗的12例慢性分歧韧带损伤患者资料。男4例,女8例;年龄(41.4±9.6)岁;左足7例,右足5例;受伤至手术时间(9.3±4.3)个月。通过观察患者术后6个月足负重正、侧位影像学表现,比较术前、末次随访时负重行走时足的疼痛视觉模拟评分法(VAS)、美国足踝外科协会(AOFAS)的中足评分,以及跗横关节稳定性应力试验、运动恢复情况、并发症的发生情况评估疗效。结果所有患者术后随访(18.4±4.0)个月。术后(6.8±3.9)个月完全恢复至体育活动。所有患者伤口均Ⅰ期愈合,1例患者发生皮神经损伤皮肤麻木并发症,经保守治疗后症状消失。所有患者术后6个月足负重正、侧位X线上可见"双谐波曲线"、跟骰关节及跟舟关节间隙正常、关节位置匹配度可,跟骰关节均处于稳定状态,无复发或加重情况出现。VAS评分由术前的[6.5(5.6,7.0)分]降低至末次随访时的[0.0(0.0,1.0)分],AOFAS的中足评分由术前的(55.6±8.8)分提高至末次随访时的(92.3±2.6)分,差异均有统计学意义(P<0.05)。跗横关节稳定性应力试验检查见关节稳定。结论利用自体半腱肌肌腱重建跟骰韧带和跟舟韧带治疗分歧韧带损伤,恢复分歧韧带稳定,足踝功能改善明显,术后并发症少,是一种可供选择的分歧韧带损伤治疗的方法。Objective To explore the clinical efficacy of reconstructing the calcaneocuboid and calcaneonavicular ligaments with the autologous semitendinosus for chronic bifurcate ligament injury.Methods A retrospective study was conducted to analyze the clinical data of 12 patients with chronic bifurcate ligament injury who had been treated by anatomical reconstruction with the autologous semitendinosus from March 2018 to January 2021 at Department of Foot and Ankle Surgery,The Fourth Hospital of Wuhan.There were 4 males and 8 females with an age of(41.4±9.6)years.Seven left and 5 right feet were affected;the time from injury to surgery was(9.3±4.3)months.The surgical efficacy was evaluated based on anteroposterior and lateral imaging assessments of foot weight-bearing at 6 months postoperation,comparison of the visual analogue scale(VAS)pain scores for foot weight-bearing walking and the American Orthopaedic Foot and Ankle Society(AOFAS)midfoot scores between preoperation and the last follow-up,stress test for stability of the transverse tarsal joint,recovery of movement,and occurrence of complications.Results All patients were followed up for(18.4±4.0)months.Their sports activities were completely resumed after postoperative(6.8±3.9)months.Primary wound healing was achieved in all patients.One patient suffered from cutaneous nerve lesion and skin numbness,the symptoms of which disappeared after conservative treatment.Double harmonic curves were observed on the anteroposterior and lateral imaging films of foot weight-bearing in all patients.The spaces in the calcaneocuboid and the calcaneonavicular joints were normal,the articular positions were matched,and the calcaneocuboid joint was stable without recurrence or worsening of displacement.The VAS decreased significantly from preoperative 6.5(5.6,7.0)to 0.0(0.0,1.0)at the last follow-up,and the AOFAS mid-foot score increased significantly from preoperative(55.6±8.8)points to(92.3±2.6)points at the last follow-up(P<0.05).The stress test for the stability of the trans

关 键 词：踝外侧韧带 足关节 关节不稳定性 韧带重建 分歧韧带 

分 类 号：R687.2[医药卫生—骨科学]