Sugimoto Kazuya, Takakura Yoshinori, Kumai Tsukasa, Iwai Makoto, Tanaka Yasuhito
Department of Orthopaedic Surgery, Saiseikai Nara Hospital, Hachijo, Nara-shi, Nara 630-8145, Japan.
Am J Sports Med. 2002 May-Jun;30(3):340-6. doi: 10.1177/03635465020300030701.
Unsatisfactory long-term results have been reported after use of a Broström repair for patients with chronic ankle ligament insufficiency.
Repair or reconstruction of both the anterior talofibular and calcaneofibular ligaments is essential for normal kinematics of the ankle-hindfoot.
Case series.
Thirteen patients with chronic instability of the ankle were found at operation to have injuries of both the anterior talofibular and calcaneofibular ligaments, with a lack of healthy ligament margins suitable for suturing. Reconstruction of the ligaments was performed with bone-patellar tendon graft. The score devised by Good et al. was used to assess the patients' clinical condition before the operation and at final follow-up.
Before the operation, six patients had a grade 3 clinical condition and seven had a grade 4 condition. At a mean follow-up of 26.5 months, all patients had a grade 1 condition. The average talar tilt of the patients was improved from 18.4 degrees +/- 5.5 degrees to 4.9 degrees +/- 2.6 degrees, and the average anterior drawer sign was improved from 9.1 +/- 2.6 mm to 5.8 +/- 1.6 mm.
In cases of combined injuries, short-term results of reconstruction of the anterior talofibular and calcaneofibular ligaments using bone-split patellar tendon graft were good, with a low frequency of complications.
对于慢性踝关节韧带功能不全的患者，采用布罗斯特罗姆修复术治疗后的长期效果并不理想。
修复或重建距腓前韧带和跟腓韧带对于踝-后足的正常运动学至关重要。
病例系列研究。
13例踝关节慢性不稳定患者在手术中被发现距腓前韧带和跟腓韧带均受损，且缺乏适合缝合的健康韧带边缘。采用骨-髌腱移植进行韧带重建。使用古德等人设计的评分系统评估患者术前及最终随访时的临床状况。
术前，6例患者临床状况为3级，7例为4级。平均随访26.5个月时，所有患者临床状况均为1级。患者平均距骨倾斜度从18.4度±5.5度改善至4.9度±2.6度，平均前抽屉试验从9.1±2.6毫米改善至5.8±1.6毫米。
在合并损伤的病例中，采用劈开髌骨肌腱移植重建距腓前韧带和跟腓韧带的短期效果良好，并发症发生率低。
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