[1]李琦,尚林,马富强,等.第三腓骨肌肌腱解剖重建距腓前韧带治疗陈旧性距腓前韧带损伤[J].中医正骨,2021,33(04):71-74.
　LI Qi,SHANG Lin,MA Fuqiang,et al.Anatomical reconstruction of anterior talofibular ligaments with peroneus tertius tendon for treatment of old anterior talofibular ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(04):71-74.
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第三腓骨肌肌腱解剖重建距腓前韧带治疗陈旧性距腓前韧带损伤()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年04期
页码:
71-74
栏目:
临床报道
出版日期:
2021-04-20

文章信息/Info

Title:
Anatomical reconstruction of anterior talofibular ligaments with peroneus tertius tendon for treatment of old anterior talofibular ligament injuries
作者:
李琦; 尚林; 马富强; 张小龙; 王亚磊; 孙士强; 贾光辉; 王翔宇
(郑州市骨科医院,河南 郑州 450052)
Author(s):
LI Qi; SHANG Lin; MA Fuqiang; ZHANG Xiaolong; WANG Yalei; SUN Shiqiang; JIA Guanghui; WANG Xiangyu
关键词:
踝损伤;  外侧韧带; 踝;  距腓前韧带;  第三腓骨肌;  移植; 自体
摘要:
目的:观察第三腓骨肌肌腱解剖重建距腓前韧带治疗陈旧性距腓前韧带损伤的临床疗效和安全性。方法:2016年5月至2019年7月,采用第三腓骨肌肌腱解剖重建距腓前韧带治疗陈旧性距腓前韧带损伤患者16例,男9例、女7例。年龄20～55岁,中位数36岁。体质量指数18.6～33.7 kg·m-2。所有患者半年内有2次以上的严重踝关节扭伤史,经正规非手术疗法治疗后无效,且行改良Brostr?-Gould修复术失败。X线检查均显示距骨前移>10 mm,距骨倾斜角>9°; MRI检查提示距腓前韧带伴或不伴跟腓韧带断裂,且第三腓骨肌存在。所有患者前抽屉试验和内翻应力试验均为阳性。踝关节初次扭伤至手术时间 12～24个月,中位数18个月。采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价踝关节疼痛情况,采用美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分和足踝功能测试(foot and ankle ability measure,FAAM)评分评价踝关节功能恢复情况,并随访观察并发症发生情况。结果:本组患者手术时间65～90 min,中位数70.5 min。切口均甲级愈合,前抽屉试验和内翻应力试验均为阴性。所有患者均获得随访,随访时间12～20个月,中位数18个月。踝关节疼痛VAS评分,术前(6.13±0.64)分、术后1年(1.33±0.74)分; AOFAS踝与后足功能评分,术前(52.47±7.37)分、术后1年(89.23±5.75)分,优11例、良5例; FAAM评分,术前(58.67±5.70)分、术后1年(90.13±6.60)分,优9例、良7例。均无感染、神经损伤等并发症发生。结论:采用第三腓骨肌肌腱解剖重建距腓前韧带治疗陈旧性距腓前韧带损伤,能缓解踝关节疼痛,促进踝关节功能恢复,且并发症少。

参考文献/References:

[1] GRIBBLE P A,TERADA M,BEARD M Q,et al.Prediction of lateral ankle sprains in football players based on clinical tests and body mass index[J].Am J Sports Med,2016,44(2):460-467.
[2] LARSEN E.Static or dynamic repair of chronic lateral ankle instability.A prospective randomized study[J].Clin Orthop Relat Res,1990(257):184-192.
[3] PERRICH K D,GOODWIN D W,HECHT P J,et al.Ankle ligaments on MRI:appearance of normal and injured ligaments[J]. Am J Roentgenol,2009,193(3):687-695.
[4] FERRAN N A,MAFFULLI N.Epidemiology of sprains of the lateral ankle ligament complex[J].Foot Ankle Clin,2006,11(3):659-662.
[5] 刘欣,黄真.慢性踝关节不稳的研究进展[J].中国全科医学,2015,18(33):4132-4136.
[6] HU C Y,LEE K B,SONG E K,et al.Comparison of bone tunnel and suture anchor techniques in the modified Brostr? procedure for chronic lateral ankle instability[J].Am J Sports Med,2013,41(8):1877-1884.
[7] XU H X,CHOI M S,KIM M S,et al.Gender Differences in outcome after modified Brostr? procedure for chronic lateral ankle instability[J].Foot Ankle Int,2016,37(1):64-69.
[8] ROOS E M,BRANDSSON S,KARLSSON J,et al.Validation of the foot and ankle outcome score for ankle ligament reconstruction[J].Foot Ankle Int,2001,22(10):788-794.
[9] OZEKI S.Simultaneous strain measurement with determination of a zero strain reference for the medial and lateral ligaments of the ankle[J].Foot Ankle Int,2002,23(9):825-832.
[10] FONG D T,HONG Y,CHAN L K,et al.A systematic review on ankle injury and ankle sprain in sports[J].Sports Med,2007,37(1):73-94.
[11] 安振齐,金旭峰,金沧海,等.自体部分腓骨短肌腱双束重建手术治疗距腓前韧带损伤[J].中国骨与关节损伤杂志,2020,35(8):872-874.
[12] 夏志勇,陈少鹏,高建国,等.同种异体肌腱解剖重建修复慢性踝关节外侧不稳[J].中华创伤骨科杂志,2016,18(12):1092-1095.
[13] 胡牧,徐向阳,刘津浩,等.自体与异体肌腱微创重建踝关节外侧韧带的临床对比研究[J].中华骨科杂志,2014,34(4):448-453.
[14] MAFFULLI N,SPIEZIA F,TESTA V,et al.Free gracilis tendon graft for reconstruction of chronic tears of the achilles tendon[J].J Bone Joint Surg Am,2012,94(10):906-910.
[15] SIEGLER S,BLOCK J,SCHNECK C D.The mechanical characteristics of the collateral ligaments of the human ankle joint[J].Foot Ankle,1988,8(5):234-242.
[16] ROURKE K,DAFYDD H,PARKIN I G.Fibularis tertius:revisting the anatomy[J].Clin Anat,2007,20(8):946-949.
[17] 尚林,王翔宇,徐俊峰,等.第三腓骨肌重建距腓前韧带结合中药薰洗治疗慢性踝关节外侧不稳[J].中医正骨,2018,30(6):58-61.
[18] 尚林,王翔宇,王爱国,等.距腓前韧带重建联合踝关节镜术治疗慢性踝关节外侧不稳[J].中国矫形外科杂志,2019,27(8):744-748.
[19] 马富强,王翔宇,徐俊峰,等.第三腓骨肌动力解剖重建外侧副韧带[J].中国矫形外科杂志,2019,27(10):934-937.
[20] DE GUSM? L C B,LIMA J S B,DUARTE F H G,et al.Anatomical basis for the use of the fibularis tertius muscle in myocutaneous flaps[J].Rev Bras Cir Plást,2013,28(2):191-195.

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备注/Memo

备注/Memo:
基金项目:河南省医学科技攻关计划项目(201503237)
通讯作者:王翔宇 E-mail:453616978@qq.com
更新日期/Last Update: 1900-01-01