腓骨长肌腱解剖重建治疗慢性踝关节不稳的疗效分析

Anatomic Reconstruction of Peroneus Longus Tendon in the Treatment of Chronic Ankle Instability

摘要: 目的：探讨腓骨长肌用于距腓前韧带和跟腓韧带重建手术对慢性踝关节外侧不稳患者的疗效分析。方法：总结了自2017-10至2018-11我科收治的17名距腓前韧带联合跟腓韧带损伤的慢性踝关节不稳的患者，均为男性军人，受伤年龄24.35 ± 4.96 (18~34)岁，在硬腰联合麻醉下行距腓前韧带和跟腓韧带重建手术，选择腓骨长肌腱作为移植物，在韧带的腓骨止点选择锚钉固定，跟骨和距骨选择界面螺钉固定。采用AOFAS评分系统、Tenger评分以及VAS评分系统对患者手术前、后的结果进行评估，并与末次随访时进行磁共振及X线检查。结果：17例患者平均获得20.59 ± 3.14 (12~24)个月随访，AOFAS评分：术前平均43.29 ± 6.98 (23~54)，末次随访平均85.24 ± 8.70 (59~96)，t = −20.532，P < 0.01，差异有统计学意义；Tenger评分：术前平均3.24 ± 0.83 (1~4)，末次随访平均7.41 ± 1.06，t = −16.97，P < 0.01，差异有统计学意义；VAS评分：术前平均3.00 ± 0.79，末次随访平均1.29 ± 0.91，t = 8.26，P < 0.01，差异有统计学意义。1例患者因距骨软骨损伤严重伴有夜间疼痛，术后关节活动仍疼痛，但无夜间痛。结论：解剖重建距腓前韧带和跟腓韧带是治疗慢性踝关节外侧不稳的一种有效手术方式，腓骨长肌作为移植物具有非常好的治疗效果。

Abstract: Objective: To investigate the effect of peroneus longus for reconstruction of the anterior talofibular ligament and calcaneus ligament in patients with chronic lateral instability of the ankle joint. Methods: 17 patients with chronic ankle instability due to injuries to the anterior peroneal ligament and calcaneofibulare ligament were treated in our department from 2017-10 to 2018-11, all of them are male soldiers, the age of injury was 24.35 ± 4.96 (18 - 34) years, reconstruction of anterior talofibular ligament and calcaneofibulare ligament was performed under combined epidural anesthesia, all patients were treated with peroneal longus autograft, selected the anchor at the fibula footprint of the ligaments for fixation, and calcaneus and talus selected interfere screw for fixation. AOFAS, Tenger and VAS were used to evaluate the outcomes about preoperative and postoperative surgery, MRI and X-ray examination were performed at the last follow-up. Results: All 17 patients were followed up for mean 20.59 ± 3.14 (12 - 24) months, AOFAS score: preoperative was mean 43.29 ± 6.98 (23 - 54), final follow-up was mean 85.24 ± 8.70 (59 - 96), t = −20.532, P < 0.01, the difference was statistically significant; Tenger score: preoperative was mean 3.24 ± 0.83 (1 - 4), final follow-up was mean 7.41 ± 1.06, t = −16.97, P < 0.01, the difference was statistically significant; VAS score: preoperative mean was 3.00 ± 0.79, final follow-up was mean 1.29 ± 0.91, t = 8.26, P < 0.01, the difference was statistically significant. One patient had severe injury of talus cartilage accompanied by pain at night, postoperative activity is still painful, but no pain at night. Conclusions: Anatomic reconstruction of anterior talofibular ligament and calcaneofibulare ligament is an effective surgical method for chronic lateral ankle instability; the peroneal longus muscle has a very good therapeutic effect as a graft.