CAJ | 학술논문

目的探讨踝关节内韧带损伤后内侧不稳定的病理机制.方法患者15例,男8例,女7例;年龄22～58岁,平均40岁.其中踝关节急性扭伤患者2例,踝关节慢性损伤3例,先天性平足3例,胫后肌腱失能5例,旋前外旋骨折1例,陈旧性的内踝撕脱骨折1例.所有患者均行三角韧带修补术,同时行跟骨延长术8例,内侧楔骨闭合截骨5例,跟骨截骨内移术1例.全部患者术后随访7～56个月,运用美国足踝外科协会(America Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分进行评估,统计学分析采用t检验.结果 1例踝关节急性骨折患者,由于术前无法评分,不放在统计分析内.其余14例患者术前评分为(42.4±10.6)分,术后评分(89.8±6.2)分(P＜0.05).结论三角韧带是一个重要的解剖结构,在以下几种情况下须注意其修复:(1)三角韧带损伤范围较广,涉及前部的胫弹簧韧带和胫舟韧带.(2)先天性的平足以及获得性的胫后肌腱失能患者.(3)以往有经常的踝关节扭伤,有外侧韧带的损伤,此次发生了伴有内侧韧带损伤的骨折.
목적 탐토과관절내인대손상후내측불은정적병리궤제.방법 환자15례,남8례,녀7례;년령22～58세,평균40세.기중과관절급성뉴상환자2례,과관절만성손상3례,선천성평족3례,경후기건실능5례,선전외선골절1례,진구성적내과시탈골절1례.소유환자균행삼각인대수보술,동시행근골연장술8례,내측설골폐합절골5례,근골절골내이술1례.전부환자술후수방7～56개월,운용미국족과외과협회(America Orthopedic Foot and Ankle Society,AOFAS)과-후족공능평분진행평고,통계학분석채용t검험.결과 1례과관절급성골절환자,유우술전무법평분,불방재통계분석내.기여14례환자술전평분위(42.4±10.6)분,술후평분(89.8±6.2)분(P＜0.05).결론 삼각인대시일개중요적해부결구,재이하궤충정황하수주의기수복:(1)삼각인대손상범위교엄,섭급전부적경탄황인대화경주인대.(2)선천성적평족이급획득성적경후기건실능환자.(3)이왕유경상적과관절뉴상,유외측인대적손상,차차발생료반유내측인대손상적골절.
Objective To discuss the pathomechanism of medial ankle instability after medial ligament injury. Methods The study involved 15 patients including eight males and seven females, at average age of 40 years (range 22-58 years). There were two patients with acute ankle sprain, three with chronic ankle injury, three with congenital pes planus, five with posterior tibial tendon dysfunction, one with pronation external rotation ankle fracture and one with old avulsion medial malleolus. All patients were treated surgically with deltoid ligament repair, when eight patients further received calcaneal lengthing osteotomy, five received medial cuneiform close wedge osteotomy and one received medial shift calcaneal osteotomy. All patients were followed up for 7-56 months. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale was used for pre- and post-operative evaluation of the function. All data were analyzed using t test. Results The clinical data of one patient was excluded from the statistical analysis because AOFAS ankle-hindfoot scale could not be applied for evaluating the acute ankle fracture. The AOFAS ankle-hindfoot scale was 42.4 + 10.6 before surgery and 89.8 +6.2 at the final followup for 14 patients (P＜0.05). Conclusions Deltoid ligament is an important anatomical structure.More attention should be paid to its repair under following aonditions: ( 1 ) the injury of the deltoid ligament involves tibiospring and tibionavicular ligament; (2) patients have congenital pes planus and posterior tibial tendon dysfunction; (3) patients present with ankle fractures and have history of repeated ankle sprain.