摘要：
Objective To compare the clinical effects of autologous semitendinosus tendon and allogenic tendon arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) combined with calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability.Methods A retrospective analysis was made of 55 patients with chronic lateral ankle instability who underwent arthroscopic reconstruction of ATFL combined with CFL from January 2012 to June 2017.A total of 28 cases were treated with autologous semitendinosus tendon (autologous group),including 19 males and 9 females,with an average age of 28.5±8.03 years (range,16-46 years).A total of 27 cases were treated with allogenic tendon (allogenic group),including 17 males and 10 females,with an average age of 27.48±7.89 years (range,16-46 years).ATFL/CFL was reconstructed by the same method in both groups.The reconstruction methods were the same between the groups.The talus and calcaneus were fixed with absorbable compression nails.Results The operation duration in the autologous group was 94.07±7.83 min,which was longer than that in the allogeneic group 63.56±7.96 min (t=14.51,P＜0.001).Fever days 5.26±0.90 days in allogeneic group were longer than 2.46±0.74 days in autologous group (t=-12.55,P＜0.001).Wound healing duration in allogeneic group was 13.44±3.33 days longer than that in autologous group 10.32±2.34 days (t=-4.01,P＜0.001).In the autologous group,28 cases were followed up for 34.54± 16.04 months,and 27 cases in the allograft group were followed up for 42.74± 17.79 months.The mean AOFAS score improved from 63.64± 11.20 before operation to 90.21 ±4.48 after operation in the autologous group,and that improved from 63.93± 10.59 before operation to 89.56±5.15 after operation in the allogeneic group with no significant difference between the two groups after operation (t=0.506,P=0.615).The mean VAS score decreased from 5.79± 1.79 before operation to 1.54± 1.35 after operation in the autologous group,and from 5.89± 1.78 before operation to 2.04± 1.32 after operation in the allogeneic group.There was no significant difference between the two groups after operation (t=-1.396,P=0.168).Tegner score increased from 4.07± 1.39 to 6.43± 1.14 in the autologous group and from 3.85±1.06 to 6.52±0.85 in the allogeneic group with no significant difference between the two groups after operation (t=-0.333,P=0.740).Stress radiographic showed that the talar tilt angle decreased from 15.60°±3.86° to 6.01°±2.64° in the autologous group,16.99°±3.78° to 7.14°±3.34° in the allogeneic group,and there was no significant difference between the two groups after operation (t=-1.382,P=0.171).Anterior talar displacement reduced from 10.82±3.12 mm to 4.03±1.69 mm in the autologous group,from 10.10±2.02 mm to 4.17±1.52 mm in the allogeneic group,and there was no significant difference between the two groups after operation (t=-0.326,P=0.746).No donor tendon dysfunction was found in the autologous group.At the end of follow-up,there was no difference in ankle dorsiflexion,plantar flexion and hind foot mobility between autologous group and allogeneic group.Conclusion Arthroscopic autologous tendon and allogeneic tendon reconstruction of AFTL combined with CFL can obtain satisfactory short-term results.The autologous tendon group was superior to the allogeneic group in terms of fever,wound healing time.However,there was no significant difference in clinical effects between the two groups.%目的 探讨关节镜下自体半腱肌肌腱与同种异体肌腱解剖重建距腓前韧带联合跟腓韧带治疗慢性踝关节外侧不稳的临床疗效.方法 回顾性分析2012年1月至2017年6月采用关节镜下距腓前韧带联合跟腓韧带重建的慢性踝关节外侧不稳患者55例.术中采用自体半腱肌腱重建(自体组)28例,男19例、女9例,年龄(28.5±8.03)岁(范围16～46岁);采用同种异体肌腱重建(异体组)27例,男17例、女10例,年龄(27.48±7.89)岁(范围16～46岁).重建方法相同,距骨端及跟骨端均采用可吸收挤压螺钉固定.结果 自体组手术时间(94.07±7.83) min,长于异体组的(63.56±7.96) min(t=14.51,P＜0.001);异体组术后发热时间为(5.26±0.90)d,长于自体组的(2.46±0.74) d(t=-12.55,P＜0.001);异体组伤口愈合时间为(13.44土3.33)d,长于自体组的(10.32±2.34)d(t=-4.01,P＜0.001).自体组随访(34.54±16.04)个月,异体组随访(42.74±17.79)个月.末次随访时,自体组美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分由术前(63.64±11.20)分提高至(90.21±4.48)分,异体组由术前(63.93±10.59)分提高至(89.56±5.15)分,术后两组差异无统计学意义(t=0.506,P=0.615);自体组视觉模拟评分(visual analogue scale,VAS)由术前(5.79±1.79)分降低至(1.54±1.35)分,异体组由术前(5.89±1.78)分降低至(2.04±1.32)分,术后两组差异无统计学意义(t=-1.396,P=0.168);自体组Teg-ner运动水平评分由术前(4.07±1.39)分提高至(6.43±1.14)分,异体组由(3.85±1.06)分提高至(6.52±0.85)分,术后两组差异无统计学意义(t=-0.333,P=0.740);自体组应力位X线片上距骨倾斜角由术前15.60°±3.86°减少至6.01°土2.64°,异体组由16.99°±3.78°减少至7.14°±3.34°,术后两组差异无统计学意义(t=-1.382,P=0.171);自体组距骨前移距离由(10.82±3.12)mm减少至(4.03±1.69) mm,异体组由(10.10±2.02) mm减少至(4.17±1.52) mm,术后两组差异无统计学意义(t=-0.326,P=0.746).自体组无一例发生膝部肌腱供区功能障碍.末次随访时所有患者患侧与健侧的踝关节背伸、跖屈活动度、后足活动度的差异均无统计学意义.结论 关节镜下自体肌腱或同种异体肌腱移植重建距腓前韧带联合跟腓韧带均可取得较为满意的近期疗效,自体肌腱移植在发热、伤口愈合时间方面优于异体肌腱移植,但临床疗效并无明显差异.
