Kramer Dennis, Solomon Ruth, Curtis Christine, Zurakowski David, Micheli Lyle J
Division of Sports Medicine, Department of Orthopaedic Surgery, Childrens Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
Foot Ankle Spec. 2011 Feb;4(1):18-28. doi: 10.1177/1938640010379912. Epub 2010 Sep 8.
There is no consensus regarding optimum surgical treatment for chronic ankle instability. The purpose of this study is to describe a variation of the Chrisman-Snook lateral ligament reconstruction that the senior author uses in patients with chronic ankle instability recalcitrant to conservative management. All patients who underwent reconstruction from 1997 to 2006 were identified, and those with a minimum 2-year follow-up were included, representing a total of 44 ankles in 43 patients. All underwent clinical evaluation and completion of the Foot and Ankle Outcome Survey and the Kaikkonen Scale. At mean follow-up of 4.4 years, mean dorsiflexion loss was 2° compared with the nonoperative side. The postoperative mean Foot and Ankle Outcome Survey score was 74 ± 16 (range, 36-98), while the mean Kaikkonen total score was 77 ± 14 (range, 40-95). Thirty-eight patients (84.6%) were satisfied with their result. Six patients (13.6%) underwent reoperation, including 4 with peroneal tendon scarring requiring tenolysis. Return to sport was achieved in 28 of 35 patients (80%) at a median of 6 months postoperatively. It is concluded that dorsiflexion loss can be minimized and return to sport expected in most patients following this variation of the Chrisman-Snook reconstruction.
对于慢性踝关节不稳的最佳手术治疗方法,目前尚无共识。本研究的目的是描述资深作者在对保守治疗无效的慢性踝关节不稳患者中采用的一种改良克里斯曼-斯诺克外侧韧带重建术。确定了1997年至2006年期间所有接受重建手术的患者,并纳入了至少随访2年的患者,共43例患者的44个踝关节。所有患者均接受了临床评估,并完成了足踝结果调查和凯科宁量表。平均随访4.4年时,与非手术侧相比,平均背屈丧失为2°。术后足踝结果调查平均评分为74±16(范围36 - 98),而凯科宁总分平均为77±14(范围40 - 95)。38例患者(84.6%)对结果满意。6例患者(13.6%)接受了再次手术,其中4例因腓骨肌腱瘢痕形成需要进行肌腱松解术。35例患者中有28例(80%)在术后中位时间6个月时恢复了运动。结论是,采用这种改良的克里斯曼-斯诺克重建术,大多数患者的背屈丧失可以降至最低,并且有望恢复运动。