| 王珂杰,戎朕,丁文鸽,张亦舸,陈海峰,戴小宇.小切口解剖重建踝关节外侧韧带治疗慢性踝关节不稳的临床研究[J].中国医学影像技术,2017,33(S1):74~77 |
| 小切口解剖重建踝关节外侧韧带治疗慢性踝关节不稳的临床研究 |
| Clinical research mini-open anatomical reconstruction of ankle lateral collateral ligments for chronic ankle instability |
| 投稿时间：2017-08-24 修订日期：2017-11-20 |
| DOI：10.13929/j.1003-3289.2017056 |
| 中文关键词: 踝关节 侧副韧带 重建 肌腱 体层摄影术,X线计算机 |
| 英文关键词:Ankle joint Collateral ligaments Reconstruction Tendons Tomography,X-ray computed |
| 基金项目:国家自然科学基金（81272017）、江苏省常州市卫计委指导性课题（wz201514）。 |
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| 中文摘要: |
| 目的 采用影像学及功能学方法评估应用小切口同种异体肌腱结合界面螺钉解剖重建踝关节外侧韧带治疗慢性踝关节外侧不稳定的中期疗效。方法 回顾性分析经手术治疗且连续随访的16例Ⅲ度陈旧性踝关节外侧副韧带损伤患者的临床资料。所有患者术前采用X线及CT规划骨道位置，术中采用微创小切口同种异体肌腱结合界面螺钉解剖重建踝关节外侧韧带。术后24个月测量X线下患侧距骨倾斜角和距骨前移距离，并通过美国足踝外科协会（AOFAS）踝关节评分和疼痛视觉模拟评分（VAS）进行客观临床评估，同时采用Good症状评级标准对患者术后主观感觉进行评估。结果 术后CT检查提示骨道位置佳，术后24个月复查，X线下距骨倾斜角由术前的（12.43±1.75）°减小为（5.15±1.54）°，距骨前移距离由术前的（11.18±1.68） mm缩小为（3.15±1.54） mm，差异均有统计学意义（P均<0.001）。AOFAS踝关节评分由术前（63.75±8.84）分提高为（90.00±2.96）分，VAS评分由术前（3.88±1.31）分降低为（1.38±0.95）分，差异均有统计学意义（P均<0.001）。Good症状评级标准：Ⅰ级10例，Ⅱ级4例，Ⅲ级2例，优良率为87.50%（14/16）。无严重并发症发生。结论 小切口同种异体肌腱结合界面螺钉解剖重建踝关节外侧韧带治疗慢性踝关节外侧不稳定安全、有效。 |
| 英文摘要: |
| Objective To evaluate the clinical effect of mini-open anatomical reconstruction of ankle lateral collateral ligaments with allogeneic tendon graft for chronic ankle instability. Methods A total of 16 patients with degree Ⅲ chronic lateral ankle instability who underwent surgery and obtained complete follow-up were retrospective analyed. All patients were treated by mini-open anatomical reconstruction of ankle lateral collateral ligaments using allogeneic tendon graft with guide of preoperative X ray and CT, which were peformed to exam the bone tunnel postoperation. Standard stress radiographs were taken to measure the talar tilt angle and talar antedisplacement before and 24 months after surgery. The pre-and post-operative ankle functions were evaluated according to American Orthopedic Foot and Ankle Society(AOFAS) scores, Visual analogue scales(VAS). The subjective feeling after operation was evaluated by the Good grading system. Results The results of CT scan after surgery indicated that all the bone tunnel were in good position. The talar antedisplacement improved significantly from (11.18±1.68)mm to (3.15±1.54)mm 24 months after surgery, and the talar tilt angle from (12.43±1.75)° to (5.15±1.54)°(both P<0.001). The average AOFAS score was 90.00±2.96 post-operation, which was significantly higher than preoperative (63.75±8.84, P<0.001). The average VAS score was 1.38±0.95, which was significantly lower than preoperative (3.88±1.31,P<0.001). There were 10 cases of grade Ⅰ, 4 cases of grade Ⅱ, 2 cases of grade Ⅲ and no case of grade Ⅳ in Good grading system, giving a good to excellent rate of 87.50%(14/16). Conclusion Mini-open anatomical reconstruction of ankle lateral collateral ligaments with allogeneic tendon graft is safe and effective for treatment of chronic lateral ankle instability. |
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