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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (12) : 960 -964. doi: 10.3877/cma.j.issn.1674-0785.2021.12.009

临床研究

腓骨双骨道解剖重建外侧韧带复合体治疗慢性踝关节外侧不稳的临床研究
张忠1, 吴海贺2, 张腾1, 齐岩松2,†()   
  1. 1. 016000　内蒙古乌海，乌海市人民医院运动医学科
    2. 010017　呼和浩特，内蒙古自治区人民医院骨关节科（运动医学中心）
  • 收稿日期:2021-10-31 出版日期:2021-12-15
  • 通信作者: 齐岩松
  • 基金资助:
    国家自然科学基金项目(81960399); 内蒙古自治区科技创新引导项目

Anatomical reconstruction of the lateral ligament complex using double fibular tunnels for treating chronic lateral malleolus instability

Zhong Zhang1, Haihe Wu2, Teng Zhang1, Yansong Qi2,†()   

  1. 1. Department of Sports Medicine, the People's Hospital of Wu Hai Inner Mongolia, Wuhai 016000, China
    2. Department of Orthopedics (Sports Medicine Center), Inner Mongolia People's Hospital, Hohhot 010017, China
  • Received:2021-10-31 Published:2021-12-15
  • Corresponding author: Yansong Qi
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张忠, 吴海贺, 张腾, 齐岩松. 腓骨双骨道解剖重建外侧韧带复合体治疗慢性踝关节外侧不稳的临床研究[J]. 中华临床医师杂志(电子版), 2021, 15(12): 960-964.

Zhong Zhang, Haihe Wu, Teng Zhang, Yansong Qi. Anatomical reconstruction of the lateral ligament complex using double fibular tunnels for treating chronic lateral malleolus instability[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(12): 960-964.

目的

探究腓骨双骨道技术解剖重建距腓前韧带和跟腓韧带的临床疗效。

方法

回顾性分析2016年1月至2019年9月诊断为慢性踝关节外侧不稳并于乌海市人民医院行腓骨双骨道解剖重建距腓前韧带和跟腓韧带的患者31例，术前与术后24个月随访时对患者进行踝关节活动度测量、美国足踝外科学会（AOFAS）评分、卡尔森踝关节功能（KAF）评分、日本足踝外科学会（JSSF）和疼痛视觉模拟（VAS）评分，比较分析手术前后患者踝关节功能恢复情况。

结果

31例患者平均随访时间为26.9±6.2个月，术后24个月患侧踝关节背伸、跖屈、内翻和外翻活动范围较术前均减小，其中跖屈和内翻较术前活动度显著降低（P＜0.05）；术后患侧跖屈、内翻较健侧活动度显著降低（P＜0.05）。术后24个月AOFAS评分为（83.96±3.77）分、KAF评分为（90.80±3.78）分、JSSF评分为（92.09±3.65）分，较术前显著提高（P＜0.001）；VAS评分为（2.06±1.20）分，较术前显著降低（P＜0.001）。

结论

腓骨双骨道解剖重建距腓前韧带和跟腓韧带可以促进腱骨愈合，获得满意的临床疗效并减少患者经济负担。

关键词: 距腓前韧带, 跟腓韧带, 解剖重建, 双骨道
Objective

To assess the clinical efficacy of anatomical reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) using double fibular tunnel technique.

Methods

A retrospective study was performed on 31 patients diagnosed with chronic lateral malleolus instability, who underwent anatomical reconstruction of the ATFL and CFL using double fibular tunnels from January 2016 to September 2019 at the People's Hospital of Wuhai, Inner Mongolia. The ankle range of motion, American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson ankle functional (KAF) score, Japanese Society for Surgery of the Foot (JSSF) score, and visual analogue scale (VAS) score were measured preoperatively and 24 months postoperatively, and the recovery of ankle function after surgery was assessed.

Results

The mean follow-up time of the 31 patients was 26.9±6.2 months. At 24 months postoperatively, the range of motion of dorsiflexion, plantarflexion varus, and valgus on the affected side was significantly lower than that before operation, and the range of motion of plantarflexion and varus decreased significantly compared with that before operation (P＜0.05). After operation, the activity of plantarflexion and varus on the affected side was significantly lower than that on the healthy side (P＜0.05). At 24 months postoperatively, the AOFAS score was (83.96±3.77), KAF score was (90.80±3.78), and JSSF score was (92.09±3.65), all of which were significantly increased compared with the pre-operative scores (P＜0.001). The VAS score at 24 months postoperatively was (2.06±1.20), which significantly decreased compared with that before operation (P＜0.001).

Conclusion

Anatomical reconstruction of the ATFL and CFL using the fibular double tunnel technique can promote tendon-bone healing, achieve satisfactory clinical efficacy, and reduce the economic burden of patients.

Key words: Anterior talofibular ligament, Calcaneofibular ligament, Anatomic reconstruction, Double bone tunnels
图1 患者腓骨双骨道重建ATFL和CFL术后骨道位置的CT表现。图a为双骨道位置示意图；图b为术后冠状位腓骨双骨道位置；图c为术后矢状位腓骨双骨道位置；图d为术后矢状位距骨、跟骨骨道位置注：ATFL为距腓前韧带；CFL为跟腓韧带
表1 手术前后患侧与健侧踝关节活动度比较（
xˉ
±s）
侧别 踝关节背伸（°） 踝关节跖屈（°） 踝关节内翻（°） 踝关节外翻（°）
术前 术后 术前 术后 术前 术后 术前 术后
患侧 14.32±3.91 13.90±3.78 48.12±5.17 43.19±6.35a 28.77±8.45 15.54±4.85a 12.93±5.15 11.74±3.51
健侧 14.06±3.89 14.06±3.89 46.06±4.36 46.06±4.36 25.25±1.29 25.25±1.29 12.93±5.15 12.93±5.15
t值 -1.278 0.456 -6.430 3.051 -2.414 12.714 -1.321 0.112
P值 0.211 0.651 ＜0.001 0.005 0.022 ＜0.001 0.019 0.912
表2 手术前后AOFAS、KAF、JSSF和VAS评分比较（分，
xˉ
±s）
组别 AOFAS KAF JSSF VAS
术前 60.06±5.68 63.06±5.59 74.54±5.26 6.09±1.27
术后 83.96±3.77 90.80±3.78 92.09±3.65 2.06±1.20
t值 -46.599 -49.364 -36.107 125.000
P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001
表3 31例患者术后24个月AOFAS中各项目评分比较（
xˉ
±s）
组别 疼痛 异常步态 支撑与自主功能 关节屈伸 后足活动 对线评分 地面步行 最大步行距离 踝关节稳定性
术前 23.55±4.86 6.71±1.90 7.74±2.01 8.00±0.00 6.00±0.00 6.94±2.47 3.06±1.06 4.58±0.92 0.00±0.00
术后 35.48±5.05 8.00±0.00 10.00±0.00 8.00±0.00 5.22±1.33 10.00±0.00 4.61±0.71 4.74±0.63 7.22±2.40
t值 9.470 3.780 6.236 - -3.230 6.892 6.730 0.803 16.733
P值 ＜0.001 ＜0.001 ＜0.001 - 0.002 ＜0.001 ＜0.001 0.425 ＜0.001
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