部分自体腓骨长肌腱解剖重建踝外侧副韧带△

Anatomic reconstruction of ankle lateral collateral ligament with partial peroneal longus tendon autograft

摘要:

［目的］ 分析部分自体腓骨长肌腱解剖重建踝外侧副韧带治疗慢性外侧踝关节不稳的疗效。［方法］ 回顾性分析 2019 年 1 月—2021 年 4 月行部分自体腓骨长肌腱进行解剖重建治疗的慢性外侧踝关节不稳 19 例患者的临床资料。记录围手术期、随访与影像资料。［结果］ 所有患者均顺利完成手术，手术时间 （100.42±18.15） min，术中出血量 （47.63±13.88） ml，手术切口均甲级愈合。平均随访时间 （20.79±5.90） 个月，与术前相比，末次随访时 VAS 评分较显著下降 （P<0.05），而 AOFAS 踝-后足评分显著增加 （P<0.05）。与术前相比，踝背伸-跖屈 ROM 无显著变化 （P>0.05），而踝内-外翻 ROM 显著减少 （P< 0.05）。患者满意度：非常满意 10 例 （52.63%），满意 7 例 （36.84%），一般 2 例 （10.53%）。影像方面，与术前相比，末次随访时应力位影像测量的 TT 和 ATT 均显著减少 （P<0.05）。其中 16 例患者末次随访时 MRI 或肌骨超声显示移植肌腱连续性良好，周围无异常水肿信号。［结论］部分自体腓骨长肌腱解剖重建踝外侧副韧带治疗慢性外侧踝关节不稳是一种安全有效可行的方法。

Abstract:

[Objective] To explore the clinical outcomes of anatomic reconstruction of ankle lateral collateral ligament with partial pero- neal longus tendon autograft for chronic lateral ankle instability. [Methods] A retrospective study was performed on 19 patients who under- went anatomical reconstruction of ankle lateral collateral ligament with partial autograft of peroneus longus tendon for chronic lateral ankle instability from January 2019 to April 2021. The perioperative, follow- up and imaging data were summarized. [Results] All the patients were successfully operated on with operative time of (100.42±18.15) min, intraoperative blood loss of (47.63±13.88) ml, and excellent inci- sion healing. At the latest interview lasted for (20.79±5.90) months the VAS score significantly decreased (P＜0.05) , whereas the AOFAS ankle-hindfoot score significantly increased compared with those preoperatively (P＜0.05) . Although there was no significant change in dor- siflexion plantarflexion range of motion (ROM) (P＞0.05) , the ROM of eversion-inversion significantly decreased at the latest follow- up compared with those preoperatively (P＜0.05) . In term of patients' satisfaction, 10 cases (52.63%) were very satisfied, 7 cases (36.84%) were satisfied, 2 cases (10.53%) of the fair. Radiographically, the talus title (TT) and anterior talar translation (ATT) on radiographs under stress at the latest follow-up significantly reduced compared with those before operation (P＜0.05) . The MRI or musculoskeletal ultrasound showed good continuity of graft tendon and no abnormal edema signal in 16 patients of them at the last follow-up. [Conclusion] Anatomical reconstruction of the ankle lateral collateral ligament with partial peroneus longus tendon autograft is a safe, effective and feasible method for the treatment of chronic lateral ankle instability.