目的 探讨下伸肌支持带移位加强联合关节囊紧缩术治疗不同残余程度距腓前韧带损伤导致慢性踝关节外侧不稳的临床疗效。方法 选取2015-06至2019-08在武警特色医学中心骨科行下伸肌支持带移位加强联合关节囊紧缩术的58例慢性踝关节外侧不稳患者,年龄18～50岁,平均(25.3±8.6)岁,随访12～26(18.1±5.5)个月,所有患者术前均对距腓前韧带残留物损伤程度进行超声、磁共振评估,术中进一步明确评估结果,术后采用足踝功能评分(foot and ankle outcome score, FAOS)随访,评估术后踝关节功能,比较不同残余程度距腓前韧带损伤的修复疗效差异。结果 58例中,术前超声检查48例可见距腓前韧带(auterjor tolofitular ligament,ATFL)残余,42例在MRI检查中可见ATFL残余,根据Cardone BW等按形态诊断ATFL损伤分级:19例韧带变薄,形态正常;10例韧带形态不规整; 29例断端萎缩或缺失。58例采用下伸肌支持带移位加强联合关节囊紧缩术治疗,术中见ATFL残余17例,缺失41例。58例均获得随访,术后患肢功能恢复满意,术后FAOS各独立分量中结果差异无统计学意义。结论 对于不同残余程度距腓前韧带损伤的慢性外踝关节不稳患者,中-短期临床随访结果表明,下伸肌支持带移位加强联合关节囊紧缩术临床疗效良好。
Abstract
Objective To study the clinical efficacy of treating chronic lateral ankle instability caused by different residual degrees of anterjor talofibular ligament (ATFL) injury by using lower extensor retinaculum displacement and joint capsule tightening. Methods The clinical data on 58 patients with chronic lateral ankle instability treated in our hospital between June 2015 and August 2019 was analyzed. These patients were treated with lower extensor retinaculum displacement combined with joint capsule tightening. Their age ranged from 18 to 50, with an average of (25.3±8.6) years old. All the patients were followed up for 12 to 26 (18.1±5.5) months. The foot and ankle outcome score (FAOS) was used to evaluate the function of ankle joints postoperatively, and the repair effect of different residual degrees of anterjor talofibular ligament injury was compared. Results Among the 58 patients screened in this study, 48 showed residual ATFL by preoperative ultrasound. ATFL residues were seen in 42 patients on MRI. According to Cardone et al, ATFL injury grade was diagnosed morphologically: ligament thinning and normal morphology in 19 cases, irregular ligament morphology in 10 cases, and atrophy or loss of broken ends in 29 cases. ATEL residues were found in 17 cases and missing in 41 cases. All the patients were treated with extensor retinaculum displacement and joint capsule compression before follow-up. The functional recovery of the affected limbs was satisfactory. There was no significant difference in the independent components of postoperative FAOSs (P＞0.05). Conclusions For patients with chronic lateral malleolus instability with different residual degrees of anterjor talofibular ligament injury, lower extensor retinaculum displacement combined with joint capsule tightening can achieve good clinical effect.
关键词
踝关节扭伤 /
距腓前韧带 /
下伸肌支持带 /
关节囊 /
慢性踝关节外侧不稳
Key words
ankle sprain /
anterjor talofibular ligament /
lower extensor retinaculum /
joint capsule /
chronic lateral ankle instability
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参考文献
[1] Doherty C,Dlahunt E,Caulfield B,et al.The incidence and prevalence of a nkle spra in injury:a systematic review and meta-analysis of prospective epidemiological studi[J].Sports Med,2014,44(1):123-140.
[2] Roos K G, Kerr Z Y, Mauntel T C, et al.The epidemiology of lateral ligament complex ankle sprains in natio-nal collegiate athletic association sports[J]. Am J Sports Med,2017,45(1):201-209.
[3] 陈明亮,谷成毅,徐留海,等.踝关节外侧副韧带损伤诊断治疗研究进展[J].中国运动医学杂志,2019,38(2):152-158.
[4] BrostrÖm L.Sprained ankles VI surgical treatment of “chronic” ligament ruptures[J].Acta Chir Scand,1966,132(5):551-565.
[5] Yeo E D, Lee K T, Sung I H, et al. Comparison of all-Inside arthroscopic and open techniques for the modified brostr-Öm procedure for ankle instability[J]. Foot Ankle Int,2016,37(10):1037-1045.
[6] Kenneth J H,Rebecca G. open brostrom for lateral ligament stabilization[J]. Curr Rev Musculoskelet Med,2020(13):788-796.
[7] Cardone B W,Erickson S J, Hartog B,et al.MRI of injury to the lateral collateral ligamentous complex of the ankle[J]. J Comput Assist Tomogr,1993,17(1):102-107.
[8] Kanamoto T,Shiozaki Y,Tanaka Y. et al. The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instabilit[J]. Bone Joint Res,2014,3(8):241-245.
[9] Cox J S. Surgical and nonsurgical treatment of acute ankle sprains[J]. Clin Orthop Relat Res,1985(198):118-126.
[10] 张 言,梁晓军,李 毅,等.改良BrostrÖm-Gould术单纯解剖修复距腓前韧带治疗慢性踝关节外侧不稳的中短期随访研究[J].中华骨与关节外科杂志, 2016, 9 (5) : 427-431.
[11] Kyung T L,Young U K,Jin S K, et al. Long term results after modified brostrom procedure without calcaneo fibular ligament reconstruction[J]. Foot Ankle Int,2011,32(2):153-157.
[12] 张凯彬,蒋逸秋,桂鉴超. 慢性踝关节外侧不稳的韧带重建手术[J].足踝外科电子杂志, 2018, 5(3): 1-5.
[13] Kocher M S,Fabricant P D,Nasreddine A Y, et al.Efficacy of the modified brostrÖm procedure for adolescent patients with chronic ateral ankle instability[J].J Pediatr Orthop,2017,37(8):537-542.
[14] Cottrell J A, Turner J C, Arinzeh T L, et al.The biology of bone and ligament healing[J].Foot Ankle Clin, 2016,21(4):739-761.
[15] Nathaniel G,David S, Jeffrey G .Early and late repair of lateral ligament of the ankle[J].Foot Ankle Int, 1980,1(2):84-89.
[16] Dalmau P Y,Yasui J,Calder D, et al. Anatomy of the inferior extensor retinaculum and its role in lateral an-kle ligament reconstruction: a pictorial essay[J]. Knee Surg Sports Traumatol Arthrosc,2016,24(4):957-962.
[17] 董 辉,刘数敬,王文良,等. MRI诊断踝关节外侧韧带损伤的Meta分析[J].武警医学,2019, 30(3) : 200-204.
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