慢性踝外侧不稳镜下清理联合外侧副韧带重建

Arthroscopic debridement combined with lateral collateral ligament reconstruction for chronic lateral ankle instability

摘要:

[目的] 评价踝关节镜关节清理联合自体腓骨短肌肌腱解剖重建外侧副韧带治疗慢性踝关节外侧不稳的临床疗效。 [方法] 2016 年 10 月—2018 年 10 月，对 18 例慢性踝关节外侧不稳患者，先行关节镜踝关节清理，然后用同侧部分腓骨短肌肌腱解剖重建距腓前韧带和跟腓韧带。采用 AOFAS 和 VAS 评分和影像检查评估临床效果。[结果] 18 例患者均顺利完成手术，未出现严重并发症。手术时间平均 (71.56±6.06) min；术中出血量平均 (46.50±5.38) ml；所有患者均获随访，随术后时推移，AOFAS 显著增加 (P＜0.05)；而 VAS 显著减少 (P＜0.05)。术后 X 线片均显示踝关节位置正常，锚钉及骨道位置良好； MRI 显示重建 ATFL 和 CFL 走形恢复正常，张力良好。[结论]踝关节镜关节清理联合部分腓骨短肌肌腱解剖重建外侧副韧带治疗慢性踝关节外侧不稳的临床效果满意，具有创伤小、操作简单和并发症少等优点。

Abstract:

[Objective] To evaluate the clinical efficacy of ankle arthroscopic debridement combined with anatomical reconstruction of the lateral collateral ligament by autograft peroneus brevis tendon for chronic lateral ankle instability. [Methods] From October 2016 to Oc- tober 2018, a total of 18 patients received ankle arthroscopic debridement, followed by anatomical reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) with ipsilateral part of peroneus breus tendon for chronic lateral ankle instability. The clinical outcomes were assessed by using AOFAS and VAS scores, as well as radiographic examination. [Results] All the 18 patients were successfully operated on without serious complications, while with operation time of (71.56 ± 6.06) min and intraoperative blood loss of (46.50±5.38) ml. Over time during follow up lasted for (19.89±1.68) months, the AOFAS score significantly increased (P＜0.05) , whereas the VAS score significantly decreased (P＜0.05) . As findings on postoperative X-rays, ankle alignment was normal with anchor and bone tunnel in proper position. In addition, the MRI revealed that the reconstructed ATFL and CFL were in normal shape with proper tension. [Conclusion] Ankle arthroscopic debridement combined with anatomical reconstruction of the lateral collateral ligament by using partial peroneus brevis tendon for chronic lateral ankle instability does achieve satisfactory clinical results, with the advantages of less trauma, sim- ple operation and fewer complications.