微创小切口外侧韧带重建治疗慢性踝关节不稳定-现代医学

微创小切口外侧韧带重建治疗慢性踝关节不稳定

单位：南京医科大学附属南京医院(南京市第一医院)骨科, 江苏南京 210006

分类号：R684

出版年·卷·期（页码）：2017·36·第七期（899-902）

摘要：

目的：探讨微创小切口外侧韧带重建治疗慢性踝关节外侧不稳定的临床疗效。方法：2009年3月至2013年12月，共收治踝关节反复扭伤所致外侧不稳定的患者23例。其中男10例，女13例；年龄22-61岁，平均37.4岁；左侧12例，右侧11例。所有患者术前均进行踝关节磁共振检查，以评估踝关节软骨及外侧韧带的情况。术中采用微创小切口自体半腱肌重建距腓前韧带及跟腓韧带。观察手术时间、出血量、关节稳定性及并发症情况。术前、术后踝关节功能应用AOFAS评分进行统计，评价临床疗效。此外，患者术前及末次随访时进行踝关节应力下前抽屉试验并摄片，测量距骨前移距离并进行统计学分析。结果：所有患者获得18-24个月的随访。随访期间未发生内植物排斥、深部感染、骨髓炎及韧带失效等并发症；1例切口浅表感染，经清创换药后愈合。所有患者术前、术后1、3、6、12个月的AOFAS评分分别为52.6±6.9、77.5±5.8、80.2±6.3、81.9±6.8、82.7±7.8。术前、术后AOFAS评分具有显著的统计学差异（P<0.05）。距骨前移距离由术前的（8.23±3.65）mm改善为末次随访时的（3.43±1.35）mm，差异有统计学意义（P<0.05）。结论：应用微创小切口踝关节外侧韧带重建，手术疗效确切，具有手术创伤小，术后患者恢复快等优点，值得临床推广应用。

Objective: To explore the effect of the lateral ligament reconstruction in the treatment of chronic ankle instability by minimally invasive incision. Methods: From March 2009 to December 2013, 23 patients of lateral ligament damage caused by sprained underwent surgery using proposed methods. They were 10 men and 13 women, with a mean age of 37.4 years (range,22 to 61 years). Left side was 11 cases and 12 cases on the right side. All patients were received ankle MRI before operation to assess the ankle cartilage and lateral ligament conditions. During the operation, using autologous semitendinosus to reconstruct anterior talofibular ligament and calcaneofibular ligament through minimally invasive incision. To observe the operation time, bleeding, joint stability and complications. AOFAS was applied for statistical collection at preoperative and postoperative to evaluate clinical efficacy. Standard stress radiographs were used to assess the patients preoperation and at the last follow-up. Results: All patients received 18~24 months follow-up. During this time, no implant rejection, no deep infection, no osteomyelitis and ligaments failure or other complications. One case of superficial incision infection, and healed after debridement dressing. The AOFAS score of all patients underwent preoperative and postoperative 1,3,6,12 months were (52.6±6.9)、77.5±5.8、(80.2±6.3)、(81.9±6.8)、(82.7±7.8);The difference of AOFAS score of preoperative and postoperative was statistical significant(P<0.05). Their average anterior drawer sign improved from (8.23±3.65)mm to(3.43±1.35)mm, and the difference was statistical significant(P<0.05). Conclusion: Applying minimally invasive incision for ankle lateral ligament reconstruction, the surgery effect is certain, the advantage was less trauma, quicker recovery, etc, and it is worthy of widely clinical application.

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