Trichine Faycal, Friha Toufik, Boukabou Azzedine, Belaid Lamine, Bouzidi Terek, Bouzitouna Mahdjoub
Surgeon, Department of Orthopaedic Surgery and Traumatology, University Military Hospital of Constantine, Constantine, Algeria.
Surgeon, Department of Orthopaedic Surgery and Traumatology, University Military Hospital of Constantine, Constantine, Algeria.
J Foot Ankle Surg. 2018 Mar-Apr;57(2):226-231. doi: 10.1053/j.jfas.2017.06.010. Epub 2017 Aug 18.
Chronic lateral ankle instability causes significant problems with physical activity. The purpose of the present study was to evaluate the results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap. A consecutive series of 38 patients were included with a minimum follow-up duration of 2 years. The functional results were assessed using the Karlsson and American Orthopaedic Foot and Ankle Society scale scores. The pre- and postoperative radiologic assessment was performed using stress radiographs to measure varus tilt and anterior drawer tests. All 38 patients were followed up for 2.5 to 7.2 years, and 35 patients were satisfied. The American Orthopaedic Foot and Ankle Society scale score had improved significantly from 57 (range 20 to 70) points preoperatively to 95 (range 80 to 100) points postoperatively (p < .0001), and 35 patients believed their ankle was more stable after surgery. The patients had returned to their previous sports activities an average of 4.7 (range 2 to 12) months after surgery. On the stress radiographs, the mean talar tilt angle had improved significantly from 15.2° (range 6° to 26°) preoperatively to 3.8° (range 1° to 8°) at the final follow-up visit (p < .001), and the mean anterior talar had improved significantly from 13.2 (range 8 to 18) mm preoperatively to 4 (range 4 to 7) mm at the final follow-up visit (p < .002). Regarding the prognostic factors, a link was found between the functional result and residual radiologic laxity measured on the stress radiographs. Reconstruction of the lateral ligaments for chronic ankle instability combining capsuloligamentous retensioning and reinforcement with an extensor retinaculum flap resulted in successful outcomes, excellent ankle stability, and preservation of ankle joint mobility. This technique addressed both lateral ankle and subtalar instability by developing an extraarticular interosseous ligament.
慢性外侧踝关节不稳会给身体活动带来严重问题。本研究的目的是评估使用伸肌支持带瓣进行韧带拉紧并加强的效果。连续纳入38例患者，最短随访时间为2年。使用卡尔森和美国矫形足踝协会量表评分评估功能结果。术前和术后采用应力X线片进行影像学评估，以测量内翻倾斜度和前抽屉试验。所有38例患者均随访2.5至7.2年，35例患者表示满意。美国矫形足踝协会量表评分从术前的57分（范围20至70分）显著提高至术后的95分（范围80至100分）（p < .0001），35例患者认为术后踝关节更稳定。患者术后平均4.7个月（范围2至12个月）恢复到之前的体育活动。在应力X线片上，距骨平均倾斜角从术前的15.2°（范围6°至26°）显著改善至末次随访时的3.8°（范围1°至8°）（p < .001），距骨平均前移从术前的13.2（范围8至18）mm显著改善至末次随访时的4（范围4至7）mm（p < .002）。关于预后因素，发现功能结果与应力X线片测量的残余影像学松弛之间存在关联。采用关节囊韧带拉紧并使用伸肌支持带瓣加强来重建慢性踝关节不稳的外侧韧带，取得了成功的结果、出色的踝关节稳定性并保留了踝关节活动度。该技术通过形成一条关节外骨间韧带解决了外侧踝关节和距下关节不稳的问题。
