腓骨短肌腱V双束解剖重建距腓前韧带△

V-shaped double-bundle anatomical reconstruction of the anterior talofibular ligament by using a half peroneal brevis ten⁃ don

摘要:

［目的］介绍腓骨短肌腱“V”双束解剖重建距腓前韧带（anterior talofibular ligament, ATFL）的手术技术和初步临床效果。［方法］ 对 23 例 ATFL 断裂的患者取自体部分腓骨短肌腱“V”双束重建距腓前韧带，以 ATFL 走行为中心作弧形切口，暴露 ATFL，确认残余韧带组织无法直接缝合。分别于 ATFL 腓骨解剖止点印迹的上缘和下缘，以及距骨解剖止点印迹片建立 3 处骨隧道。用取腱器纵向切取一半的腓骨短肌腱，制备 V 形移植物。将移植物分别引入相应骨隧道，拉紧，用挤压螺钉或锚钉固定，完成双束 V 形 ATFL 重建。［结果］ 所有患者均顺利完成手术，无严重并发症，随访 12 个月以上。AOFAS 评分由术前的（46.7±9.5）分显著提高至术后 12 个月（91.6±2.8）分（P<0.05），KAF 评分由术前的（49.4±1.9）分显著提高至术后 12 个月 （90.8±2.7） 分 （P<0.05），VAS 疼痛评分由术前的 （5.8±0.9） 分显著减少至术后 12 个月 （1.7±0.9） 分 （P<0.05）。末次随访时，23 例患者 ADT 及 TTT 均为阴性，踝关节疼痛、日常功能和关节活动、稳定性及后足对线较术前均有明显改善。 ［结论］腓骨短肌腱“V”双束解剖重建 ATFL，可更好地恢复踝关节生物力学功能，临床疗效肯定。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of V-shaped double-bundle anatomical re- construction of the anterior talofibular ligament (ATFL) by using a half peroneal brevis tendon. [Methods] A total of 23 patients received abovementioned surgical treatment for chronic lateral ankle instability. Over the ATFL trace an arc incision was made to expose the liga- ment remnants, which proved unproper to be sutured directly. The bone tunnels were created individually on the upper and lower border of the anatomic fibular footprint, as well as the talar anatomic footprint. A longitudinal half peroneus brevis tendon was obtained by a tendon harvester, and prepared to V-shaped graft. Subsequently, the tendon graft was respectively introduced into the superior fibular tunnel, the inferior fibular tunnel and the talar tunnel, and tighten and fixed with interference screws or suture anchors to reconstruct the ATFL in dou- ble bundles and V- shape. [Results] All patients were successfully operated on without serious complications, and were followed up for more than 12 months. The AOFAS score significantly increased from (46.7±9.5) before operation to (91.6±2.8) 12 months after operation (P＜ 0.05), KAF score significantly increased from (49.4±1.9) to (90.8±2.7) (P＜0.05), whereas the VAS pain score significantly decreased from (5.8±0.9) before surgery to (1.7±0.9) 12 months after surgery (P＜0.05). At the latest follow-up, all the patients got negative ADT and TTT tests, had no ankle pain, and got considerably improved daily function and joint movement, stability and hindfoot alignment compared with those preoperatively. [Conclusion] This V-shaped double-bundle ATFL anatomical reconstruction with longitudinal half peroneus brevis tendon dose restore the biomechanical function of the ankle and achieve sound clinical outcome.