摘要
目的探讨无结锚钉线带法重建距腓前韧带(anterior talofibular ligament,ATFL)联合下伸肌支持带加强技术治疗慢性外踝不稳(chronic lateral ankle instability,CLAI)的临床疗效。方法回顾分析2017年8月—2023年12月收治且符合选择标准的31例CLAI患者临床资料。其中男18例,女13例;年龄20~48岁,平均34.6岁。患者均有踝关节反复扭伤史,病程6~18个月,平均9.65个月。前抽屉试验阳性,内翻应力试验阳性,韧带走行区域压痛。踝关节应力位X线片示患侧距骨倾斜角(10.00±2.78)°,距骨前移距离(9.48±1.96)mm;MRI示ATFL连续性中断、走行迂曲或结构消失。术前疼痛视觉模拟评分(VAS)为(5.2±2.1)分,美国矫形足踝协会(AOFAS)评分为(62.9±7.1)分。均采用关节镜下踝关节清理后无结锚钉线带法重建ATFL联合下伸肌支持带加强技术治疗。术后采用VAS评分及AOFAS评分评估患者疼痛及功能;摄应力位X线片,测量距骨倾斜角和距骨前移距离,评估踝关节稳定性变化;按照Insall评价标准评估患者满意度。结果31例手术均顺利完成。1例出现切口渗液,余手术切口均Ⅰ期愈合。2例出现足背外侧麻木,术后1个月内麻木感均消失。患者均获随访,随访时间15~84个月,平均47.2个月。术后未出现锚钉脱落、松动,复发性外踝不稳,腓浅神经损伤,无排斥反应、切口感染等并发症。术后3个月复查前抽屉试验及内翻应力试验均为阴性。复查应力位X线片示距骨倾斜角为(2.86±1.72)°,距骨前移距离为(2.97±1.32)mm,与术前比较差异均有统计学意义(t=12.218,P<0.001;t=15.367,P<0.001)。末次随访时2例患者运动后出现踝关节肿胀,休息后可自行消退;31例恢复至伤前运动水平或日常活动无明显不适。25例患者无痛,4例运动后轻度疼痛,2例行走超过2000 m后轻度疼痛。末次随访时,VAS评分为(0.8±0.9)分,AOFAS评分为(91.6±4.1)分,与术前比较差异均有统计学意义(t=10.851,P<0.001;t=-19.514,P<0.001)。按照Insall评价标准评定满意度,获优24例、良4例、可3例,满意度90.3%。结论无结锚钉线带法重建ATFL联合下伸肌支持带加强技术治疗CLAI,早中期临床疗效满意。
Objective To investigate the effectiveness of the suture anchor technique without knots for reconstruction of the anterior talofibular ligament(ATFL)combined with the reinforcement of the inferior extensor retinaculum in treating chronic lateral ankle instability(CLAI).Methods The clinical data of 31 patients with CLAI who were admitted between August 2017 and December 2023 and met the selection criteria were retrospectively analyzed.There were 18 males and 13 females,with an age range from 20 to 48 years(mean,34.6 years).All patients had a history of repeated ankle sprain,with a disease duration of 6-18 months(mean,9.65 months).The anterior drawer test and inversion stress test were positive,and tenderness was present in the ligament area.Stress X-ray films of the ankle joint showed a talar tilt angle of(10.00±2.78)°and an anterior talar displacement of(9.48±1.96)mm on the affected side.MRI revealed discontinuity,tortuosity,or disappearance of the ATFL structure.Preoperatively,the visual analogue scale(VAS)score was 5.2±2.1,and the American Orthopaedic Foot and Ankle Society(AOFAS)score was 62.9±7.1.All patients underwent arthroscopic debridement of the ankle joint followed by reconstruction of the ATFL using the suture anchor technique without knots combined with reinforcement of the inferior extensor retinaculum.Postoperatively,pain and function were assessed using the VAS and AOFAS scores.Stress X-ray films were taken to measure the talar tilt angle and anterior talar displacement to evaluate changes in ankle joint stability.Patient satisfaction was assessed according to the Insall criteria.Results All 31 surgeries were successfully completed.One case had wound exudation,while the remaining surgical incisions healed by first intention.Two cases experienced numbness on the lateral aspect of the foot,which disappeared within 1 month after operation.All patients were followed up 15-84 months(mean,47.2 months).No complication such as anchor loosening,recurrent lateral ankle instability,superficial peroneal nerve injury,rejection reaction,or wound infection occurred postoperatively.The anterior drawer test and inversion stress test were negative at 3 months after operation.Stress X-ray films taken at 3 months after operation showed the talar tilt angle of(2.86±1.72)°and the anterior talar displacement of(2.97±1.32)mm,both of which were significantly different from the preoperative values(t=12.218,P<0.001;t=15.367,P<0.001).At last follow-up,2 patients had ankle swelling after exercise,which resolved spontaneously with rest;all 31 patients returned to their pre-injury level of sports or had no significant discomfort in daily activities.At last follow-up,25 patients were pain-free,4 had mild pain after exercise,and 2 had mild pain after walking more than 2000 meters.The VAS score was 0.8±0.9 and the AOFAS score was 91.6±4.1,both of which were significantly different from the preoperative scores(t=10.851,P<0.001;t=−19.514,P<0.001).According to the Insall criteria,24 patients were rated as excellent,4 as good,and 3 as fair,with a satisfaction rate of 90.3%.Conclusion The suture anchor technique without knots for reconstruction of the ATFL combined with reinforcement of the inferior extensor retinaculum provides satisfactory short-and mid-term effectiveness in treating CLAI.
作者
李冬超
王爱国
徐红阳
赵谦
黄竞敏
LI Dongchao;WANG Aiguo;XU Hongyang;ZHAO Qian;HUANG Jingmin(Department of Orthopedics,Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital,Tianjin,300120,P.R.China;The Second Department of Sport Injury and Arthroscopy,Tianjin Hospital,Tianjin,300211,P.R.China)
出处
《中国修复重建外科杂志》
北大核心
2025年第7期837-842,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
天津市公共卫生、生物医药科技重大专项重点项目(24ZXGZSY00200)
天津市卫生健康委员会中医、中西医结合科研重点项目(2023038)。
关键词
慢性外踝不稳
距腓前韧带
无结锚钉线带法
修复重建
Chronic lateral ankle instability
anterior talofibular ligament
suture anchor technique without knots
repair and reconstruction
