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自体部分腓骨长肌腱重建外侧韧带治疗慢性踝关节外侧不稳

[Lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability].

作者信息

Pan Yuehai, Qu Zhigang, Bi Benjun, Gao Fei, Huang Heng, Dong Quanyu

机构信息

Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Sep 15;34(9):1114-1119. doi: 10.7507/1002-1892.202002008.

Abstract

OBJECTIVE

To assess the effectiveness of lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability.

METHODS

Between September 2014 and November 2018, 32 patients (32 sides) with chronic lateral ankle instability were treated with lateral ankle ligament reconstruction by using autogenous anterior half of the peroneus longus tendon. There were 25 males and 7 females, with an average age of 28.5 years (range, 20-51 years). The disease duration was 6-41 months (mean, 8.9 months). The preoperative Karlsson-Peterson ankle score was 53.7±9.7. The talar tilt angle was (14.9±3.7)°, and the anterior talar translation was (8.2±2.8) mm. Six patients combined with osteochondral lesion of talus and 4 patients combined with bony impingement.

RESULTS

All incisions healed by first intention postoperatively. All patients were followed up 12-53 months (mean, 22.7 months). At last follow-up, the Karlsson-Peterson ankle score was 85.2±9.6; the talar tilt angle was (4.3±1.4)°; the anterior talar translation was (3.5±1.1) mm. There were significant differences in all indexes between pre- and post-operation ( <0.05). Seventeen patients were very satisfied with the results, 10 patients were satisfied, 4 patients were normal, and 1 patient was unsatisfied. After operation, the ankle sprain occurred in 7 cases, the tenderness around the compression screws at calcaneus in 5 cases, the anterolateral pain of ankle joint over 6 months in 4 cases. No patient had discomfort around the reciepient sites. At last follow-up, the ultrasonography examination showed that there was no significant difference in the density and diameter between bilateral peroneus longus tendons in 12 cases.

CONCLUSION

For chronic lateral ankle instability, the lateral ankle ligament reconstruction with the autogenous partial peroneus longus tendon is a safe and effective surgical option.

摘要

目的

评估自体部分腓骨长肌腱重建外侧韧带治疗慢性踝关节外侧不稳的疗效。

方法

2014年9月至2018年11月,采用自体腓骨长肌腱前半部分对32例(32侧)慢性踝关节外侧不稳患者进行踝关节外侧韧带重建。其中男性25例,女性7例,平均年龄28.5岁(20 - 51岁)。病程6 - 41个月(平均8.9个月)。术前Karlsson - Peterson踝关节评分为53.7±9.7。距骨倾斜角为(14.9±3.7)°,距骨前移为(8.2±2.8)mm。6例合并距骨骨软骨损伤,4例合并骨撞击。

结果

术后所有切口均一期愈合。所有患者均获随访,随访时间12 - 53个月(平均22.7个月)。末次随访时,Karlsson - Peterson踝关节评分为85.2±9.6;距骨倾斜角为(4.3±1.4)°;距骨前移为(3.5±1.1)mm。所有指标术前与术后比较差异均有统计学意义(<0.05)。17例患者对结果非常满意,10例满意,4例一般,1例不满意。术后发生踝关节扭伤7例,跟骨加压螺钉周围压痛5例,踝关节前外侧疼痛超过6个月4例。供区无不适。末次随访时,12例超声检查显示双侧腓骨长肌腱密度及直径差异无统计学意义。

结论

对于慢性踝关节外侧不稳,自体部分腓骨长肌腱重建外侧韧带是一种安全有效的手术选择。

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本文引用的文献

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Chronic Lateral Ankle Instability: Open Surgical Management.慢性外侧踝关节不稳:开放手术治疗
Foot Ankle Clin. 2018 Dec;23(4):539-554. doi: 10.1016/j.fcl.2018.07.002. Epub 2018 Sep 27.
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[ADVANCES IN ANATOMICAL REPAIR OF CHRONIC LATERAL ANKLE INSTABILITY].慢性外侧踝关节不稳的解剖修复进展
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Dec 8;30(12):1551-1555. doi: 10.7507/1002-1892.20160319.

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