自体肌腱重建治疗踝关节陈旧性外侧副韧带损伤的临床研究

发布时间：2018-03-08 10:15

  本文选题：踝关节外侧副韧带　切入点：腓骨长肌肌腱　出处：《四川医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察取自体部分腓骨长肌肌腱重建踝关节外侧副韧带及改良Brostr?m术两种手术方式治疗踝关节外侧副韧带陈旧性损伤的临床疗效,初步探讨取自体部分腓骨长肌肌腱重建踝关节外侧副韧带的可行性及有效性。方法:研究我院2012年8月~2013年5月,38例踝关节外侧副韧带陈旧性损伤患者,年龄18~43岁,平均30岁,男24例,女14例,病程均在4个月以上,均有踝关节疼痛,打软腿,多次扭伤病史。其中22例采用取自体部分腓骨长肌肌腱重建踝关节外侧副韧带(A组),16例采用改良Brostr?m手术(B组),观察术前术后AOFAS(美国足踝外科协会的踝与后足评分系统)评分,观察术前术后距骨倾斜角(talar tilt,TT)及距骨前移距离(anterior talar translation,ATT)的改变。并比较两组患者手术时间及并发症情况。结果:1、手术时间及一般资料B组(改良Brostr?m组)患者的平均手术时间为66.7±18.0min,A组(重建组)患者的平均手术时间为70.6±14.0min,两组病人手术时间比较(P=0.752及t=0.457,P0.05),两组病人术前距骨倾斜角(TT)比较(P=0.655及t=0.451,P0.05)、距骨前移距离(ATT)比较(P=0.978及t=0.028,P0.05)及AOFAS评分(分)比较(P=0.249及t=1.171,P0.05),两组病人在手术时间、术前TT值、ATT值及AOFAS评分的差异无统计学意义。所有患者治疗后均未出现伤口并发症、踝关节继发骨折、锚钉脱出等并发症,A组未出现腓骨长肌肌腱断裂、腓神经损伤等并发症。2、AOFAS评分平均随访时间为(20±5.7)月和(22.6±4.1)月,AOFAS评分,B组(改良Brostr?m组)术前为(59.38±2.247)分,术后末次随访为(86.50±2.160)分;A组(重建组)术前为(58.36±2.904)分,术后末次随访为(91.50±2.241)分。两组病人术后AOFAS评分比较(P=0.000,P0.01),有统计学意义,A组优于B组。治疗前后AOFAS评分提高的分值部分,A组(33.14±2.100)分,B组(26.88±2.729)分,两组比较(P=0.000,P0.01),有统计学意义,A组优于B组。两组病人术前术后AOFAS评分比较均为(P=0.000,P0.01),有统计学意义,治疗有效。3、距骨倾斜角及距骨前移距离B组(改良Brostr?m组)距骨倾斜角(TT)由术前16.0°±1.34°改善为术后的末次随访时的6.44°±1.209°,距骨前移距离(ATT)由术前7.44±1.153mm改善为末次随访时5.63±1.147mm,A组(重建组)TT由术前16.23°±1.688°改善为末次随访6.27°±1.077°,ATT由术前7.45±1.01mm改善为末次随访时5.5±1.185mm。两组病人术后TT值比较(P=0.188及t=1.342,P0.05)、ATT值比较(P=0.736及t=0.340,P0.05),两组病人术后TT、ATT值差异无统计学意义,两组病人在术后稳定性方面无明显差异。A组病人术前TT、ATT值与术后TT、ATT值比较均为(P=0.000,P0.01),B组术前TT、ATT值与术后TT、ATT值比较均为(P=0.000,P0.01),有统计学意义,术后TT、ATT值均明显优于术前。结论:1、采用取自体部分腓骨长肌肌腱重建踝关节外侧副韧带及改良Brostr?m术两种手术方法均可明显改善踝关节外侧副韧带陈旧性损伤病人术后功能及稳定性。2、采用改良Brostr?m手术与取自体部分腓骨长肌肌腱重建踝关节外侧副韧带手术在患者术后关节稳定性方面无明显差异。3、采用取自体部分腓骨长肌肌腱重建踝关节外侧副韧带较改良Brostr?m术在病人术后功能恢复方面有一定的优势。
[Abstract]:Objective: To observe the effect of autologous peroneus longus tendon reconstruction of the lateral ligament of ankle joint and modified Brostr? Two surgical methods of m in the treatment of lateral ankle ligament injury in old clinical efficacy, to explore the feasibility and effectiveness of autologous partial peroneus longus tendon reconstruction of ankle lateral collateral ligament. Methods: the study our hospital in August 2012 ~2013 year in May, 38 cases of ankle lateral ligament injury in old patients, aged 18~43 years old, average 30 years old, male 24 cases, female 14 cases, the course was more than 4 months, with ankle pain, play soft legs, repeatedly twisting injury history. There were 22 cases of autologous part of fibula long muscle tendon reconstruction of the lateral ligament of ankle joint (A group), 16 cases with modified Brostr? M surgery (B group), to observe the postoperative AOFAS (AOFAS ankle and hindfoot score system) score, observe the postoperative talar tilt (talar tilt TT) And the translation of talus (anterior talar translation, ATT) change. And compare the two groups of patients with operation time and complications. Results: 1, the operation time and the general information group B (modified Brostr? M group) the average operation time of the patients was 66.7 + 18.0min, group A (reconstruction group) average operation time of patients 70.6 + 14.0min, two groups were compared operative time (P=0.752 and t=0.457, P0.05), two groups of patients before the talar tilt (TT) comparison (P=0.655 and t=0.451, P0.05), translation of talus (ATT) comparison (P=0.978 and t=0.028, P0.05) and AOFAS score (points) compared (P=0.249 and t=1.171, P0.05), the two groups of patients at the time of surgery, preoperative TT value, there were no significant differences in ATT values and AOFAS scores. All patients had no wound complications, secondary ankle fracture, anchor prolapse and other complications in A group, there was no fracture of long peroneal muscle tendon, peroneal nerve injury 骞跺彂鐥，

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