解剖修复与非解剖重建外侧韧带治疗慢性踝关节外侧不稳

发布时间：2018-05-09 07:27

本文选题：踝关节 + 韧带损伤　；参考：《西安医学院》2017年硕士论文

【摘要】：目的:比较应用带线锚钉结合改良Brost?m术与部分腓骨短肌腱转位重建踝关节外侧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2013年4月至2015年9月在西安医学院附属红会医院足踝外科诊疗中心进行手术治疗的39例慢性踝关节外侧不稳患者资料,其中应用带线锚钉结合改良Brost?m术解剖修复踝关节外侧韧带(修复组)25例,应用部分腓骨短肌腱转位非解剖重建踝关节外侧韧带(重建组)14例,术后定期随访,记录两组患者的手术时间、伤口愈合时间以及并发症。患者术前与术后随访时均按照美国足踝外科协会(AOFAS)踝与后足评分标准、完全负重行走时的踝关节疼痛视觉模拟评分(VAS)以及Karlsson踝关节功能评分评估手术疗效。结果:平均手术时间重建组(78.5±9.1)min长于修复组(63.1±12.2)min,差异具有统计学意义(P0.05)。修复组23例获得随访,2例失访,随访时间12~41个月,平均(31.8±5.3)个月。重建组14例全部获得随访,随访时间12~38个月,平均(29.3±6.2)个月。平均AOFAS踝与后足评分,修复组术前(68.78±9.10)分,末次随访(88.35±9.74)分;重建组术前(68.50±9.16)分,术后(85.10±8.81)分。完全负重行走时踝关节平均VAS评分,修复组术前(5.55±0.97)分,末次随访(2.36±2.08)分;重建组术前(5.35±1.28)分,末次随访(2.66±1.94)分。平均Karlsson踝关节功能评分,修复组术前(59.09±14.67)分,末次随访(85.17±14.00)分;重建组术前(62.36±14.41)分,末次随访(83.07±16.44)分。各评价数据两组之间比较差异无统计学意义(P0.05),同组内末次随访时与术前比较差异有统计学意义(P0.05)。结论:应用带线锚钉结合改良Brost?m术解剖修复踝关节外侧韧带与部分腓骨短肌腱转位非解剖重建踝关节外侧韧带对治疗慢性踝关节外侧不稳均能取得良好的临床疗效,二者无显著差异。
[Abstract]:Objective: to compare the clinical effect of modified Brost?m with wire anchor nail and partial peroneal short tendon transposition in reconstruction of lateral ligament of ankle joint in the treatment of chronic lateral ankle instability. Methods: from April 2013 to September 2015, 39 patients with chronic lateral ankle instability were analyzed retrospectively who underwent surgical treatment in the Department of foot and ankle surgery, affiliated Honghui Hospital, Xi'an Medical College. Among them, the lateral ankle ligament was repaired with wire anchor nail and modified Brost?m technique (25 cases in the repair group and 14 cases in the reconstruction group by transposition of peroneal brevis tendon (14 cases). The operative time, wound healing time and complications were recorded. Preoperative and postoperative follow-up were performed according to the American Association of foot and ankle Surgical Association (Aofas) ankle and hind foot score, complete weight-bearing walking visual analogue score (VASS) and Karlsson ankle function score. Results: the mean operation time of reconstruction group was 78.5 卤9.1)min longer than that of repair group (63.1 卤12.2 min). The difference was statistically significant (P 0.05). In the repair group, 2 cases were followed up for 12 ~ 41 months, with an average of 31.8 卤5.3 months. All the 14 cases in the reconstruction group were followed up for 12 ~ 38 months with an average of 29.3 卤6.2 months. The average AOFAS scores of ankle and hind foot were 68.78 卤9.10 before operation, 88.35 卤9.74 at the last follow-up in the repair group, and 68.50 卤9.16 before operation in the reconstruction group, and 85.10 卤8.81 in the reconstruction group. The average VAS score of ankle joint was 5.55 卤0.97 before operation, 2.36 卤2.08 at the last follow-up in the repair group, and 5.35 卤1.28 before operation in the reconstruction group, and 2.66 卤1.94 at the last follow-up in the reconstruction group. The average Karlsson ankle function score was 59.09 卤14.67 before operation and 85.17 卤14.00 at the last follow-up in the repair group, while in the reconstruction group it was 62.36 卤14.41 before operation and 83.07 卤16.44 at the last follow-up. There was no significant difference between the two groups in the evaluation data (P 0.05), but there was significant difference between the two groups at the last follow-up in the same group (P 0.05). Conclusion: the reconstruction of lateral ankle ligament with thread anchor nail combined with modified Brost?m anatomical repair of lateral ankle ligament and partial fibula short tendon transposition can achieve good clinical effect in the treatment of chronic lateral ankle instability. There was no significant difference between them.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【参考文献】