Colville M R
Department of Orthopaedic Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
J Am Acad Orthop Surg. 1998 Nov-Dec;6(6):368-77. doi: 10.5435/00124635-199811000-00005.
Symptomatic ankle instability will develop in as many as 20% of patients after inversion sprain of the lateral ankle ligaments. Although most patients may be successfully treated with a rehabilitative exercise program and bracing, some will continue to sustain recurrent ankle sprains with activities of daily living, work on uneven terrain, or sports. The anterior talofibular ligament and the calcaneofibular ligament are the primary stabilizers of the lateral ankle, and surgical procedures should be aimed at restoring the normal function of these ligaments. Preoperative stress radiographs should be obtained to determine the degree of laxity and to differentiate between subtalar joint and ankle joint instability. Numerous surgical techniques have been described to correct ankle instability, most with an 80% to 90% success rate. Reconstructions using tendon grafts may restrict normal ankle and subtalar joint motion, depending on the placement of the graft. Direct repair of the anterior talofibular and calcaneofibular ligaments with shortening and reattachment to the fibula has a success rate similar to that for augmented reconstruction and avoids the increased morbidity associated with tendon graft procedures. Patients with severe laxity or with weak or deficient tissue for direct repair may require an augmented reconstruction. Osteotomy may be required in addition to ligament reconstruction in patients with severe ankle or hindfoot varus alignment, in order to prevent failure of the repair. Patients with paralysis or weakness of the peroneal musculature may require a nonanatomic procedure that limits subtalar motion.
外侧踝关节韧带内翻扭伤后，多达20%的患者会出现有症状的踝关节不稳。尽管大多数患者通过康复锻炼计划和支具固定可能得到成功治疗，但仍有一些患者在日常生活活动、在不平整地形上工作或进行体育运动时会继续反复发生踝关节扭伤。距腓前韧带和跟腓韧带是外侧踝关节的主要稳定结构，手术操作应旨在恢复这些韧带的正常功能。术前应进行应力位X线片检查，以确定松弛程度，并区分距下关节和踝关节不稳。已经描述了许多用于纠正踝关节不稳的手术技术，大多数成功率为80%至90%。使用肌腱移植物进行重建可能会限制踝关节和距下关节的正常活动，这取决于移植物的放置位置。直接修复距腓前韧带和跟腓韧带并缩短后重新附着于腓骨，其成功率与增强重建相似，且避免了与肌腱移植手术相关的发病率增加。对于严重松弛或组织薄弱或缺损而无法直接修复的患者，可能需要进行增强重建。对于严重踝关节或后足内翻畸形的患者，除韧带重建外可能还需要进行截骨术，以防止修复失败。腓骨肌群麻痹或无力的患者可能需要一种限制距下关节活动的非解剖手术。
