自体半腱肌肌腱结合界面螺钉修复慢性踝关节外侧副韧带损伤

摘要

目的观察自体半腱肌肌腱结合可吸收界面螺钉修复慢性踝关节外侧副韧带损伤的疗效。方法应用同侧自体半腱肌肌腱结合可吸收界面螺钉修复慢性踝关节外侧副韧带损伤12例，男7例，女5例；年龄23～39岁，平均(29.4±4.8)岁；病程3～6个月。于外踝处钻孔，穿过编织的自体半腱肌肌腱，肌腱两端以可吸收界面螺钉分别固定在距腓前韧带和跟腓韧带的距骨及跟骨止点处。术后6个月摄X线片测量距骨位置，以美国矫形足踝协会(American Orthopaedic Foot and Ankle Society，AOFAS)踝-后足评分系统及足踝疗效评分(Foot and Ankle Outcome Score，FAOS)进行疗效评价。结果 全部患者随访6～24个月，平均12.3个月。切口均一期愈合。距骨倾斜角由术前15.43°±1.35°减小为术后6个月3.28°±1.17°,前抽屉试验距骨前移距离由术前(7.82±0.61) mm减小为术后6个月(3.71±0.41) mm，AOFAS踝-后足评分由术前(66.92±5.63)分增加至术后6个月(93.25±2.67)分，FAOS疼痛、其他症状、日常活动、运动、生活质量五项评分分别由术前(64.67±5.00)、(59.50±5.35)、(65.42±5.02)、(52.42±4.68)、(65.58±4.32)分增加至术后6个月(88.00±3.46)、(83.75±4.37)、(91.42±3.80)、(87.92±3.26)、(93.17±2.59)分，差异均有统计学意义。结论采用自体半腱肌肌腱结合可吸收界面螺钉可以重建慢性踝关节外侧副韧带的稳定性，术后踝关节功能恢复良好，其强度能满足运动需求。%Objective To observer the effect of autograft of semitendinosus and interference screws for reconstruction of lateral ankle ligaments. Methods A total of 12 cases of injured lateral ankle ligaments were selected, including 7 males and 5 females with an average age was 29.4 years, with a course of disease from 3 to 6 months. All lateral ligaments were reconstructed by autograft of semitendinosus & bio-interference screws. A 4.5 mm diameter tunnel was drilled on the lateral ankle, where the tendon of semitendinosus was permeated through, both ends of semitendinosus tendons were fixed with bio-interference screws on talus of at the end of anterior talofibular ligament and calcaneus of at the end of calcaneofibular ligament, maintaining ankle neutral and moderate valgus position. Following operation, the ankle was fixed in neutral position and slightly valgus position with plaster cast. The wound healing, the outcomes of American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and stress radiographic evaluation were assessed at the follow-up. Results All 12 patients showed no infection and the wound healed well at the primary stage. At 3, 6, 12, 24 months after operation, all patients were followed-up. According to AOFAS and FAOS of preoperation and final follow-up postoperation, function of ankle in all patients was significantly improved (P＜0.01), the scores of Chrisman-Snook group were more lower than this approach. No patients complained of instability of the ankle, and stress radiograph confirmed this improvement. Conclusion Reconstruction of lateral ligaments of the ankle with autograft of semilendinosus & biointerference screws is a practical and reliable treatment, which restores stability and function of the ankle.