CAJ | 학술논문

目的：观察应用自体半腱肌肌腱微创重建踝关节外侧韧带的长期临床疗效。方法回顾性分析2006年9月至2012年6月采用自体半腱肌肌腱微创手术治疗慢性踝关节外侧不稳的58例患者资料，其中男34例，女24例，平均年龄32．4岁（17～62岁）。踝关节初次扭伤至接受手术的时间6～38月，平均17．3个月。本组患者均由同一手术组医师采用相同的微创手术方法，重建距腓前韧带及跟腓韧带。记录患者的手术时间、发热天数、伤口愈合时间。患者术前术后均按照美国足踝外科协会（ AOFAS）踝关节评分标准，VAS评分分别评估手术前后疗效、供区功能影响状况和患者满意度。结果本组患者手术时间75～98 min，平均（85.5±11.5） min，术后发热天数1.5～4 d，平均（2.5±1.2） d，46例获得随访。随访时间25～86个月，平均（58.5±7.4）个月。末次随访时平均AOFAS踝与后足评分，术前（62.3±8.2）分，术后（95.1±7.5）分，差异有统计学意义（P＜0.01）。6例患者行走在不平的地面上有残余的不稳定。3例患者平地行走仍有残余不稳定。所有患者无膝部肌腱供区功能障碍。术后AOFAS评分31例患者为优，9例为良。术后应力位摄片距骨倾斜角平均由14°减少到3.7°（P＜0.01），距骨前移距离平均由12.4 mm减少到4.5 mm（P＜0.01）。结论使用自体半腱肌肌腱微创重建踝关节外侧韧带手术简便，手术时间短，术后发热时间短，无排斥反应。自体肌腱愈合康复过程快，手术疗效好。
목적：관찰응용자체반건기기건미창중건과관절외측인대적장기림상료효。방법회고성분석2006년9월지2012년6월채용자체반건기기건미창수술치료만성과관절외측불은적58례환자자료，기중남34례，녀24례，평균년령32．4세（17～62세）。과관절초차뉴상지접수수술적시간6～38월，평균17．3개월。본조환자균유동일수술조의사채용상동적미창수술방법，중건거비전인대급근비인대。기록환자적수술시간、발열천수、상구유합시간。환자술전술후균안조미국족과외과협회（ AOFAS）과관절평분표준，VAS평분분별평고수술전후료효、공구공능영향상황화환자만의도。결과본조환자수술시간75～98 min，평균（85.5±11.5） min，술후발열천수1.5～4 d，평균（2.5±1.2） d，46례획득수방。수방시간25～86개월，평균（58.5±7.4）개월。말차수방시평균AOFAS과여후족평분，술전（62.3±8.2）분，술후（95.1±7.5）분，차이유통계학의의（P＜0.01）。6례환자행주재불평적지면상유잔여적불은정。3례환자평지행주잉유잔여불은정。소유환자무슬부기건공구공능장애。술후AOFAS평분31례환자위우，9례위량。술후응력위섭편거골경사각평균유14°감소도3.7°（P＜0.01），거골전이거리평균유12.4 mm감소도4.5 mm（P＜0.01）。결론사용자체반건기기건미창중건과관절외측인대수술간편，수술시간단，술후발열시간단，무배척반응。자체기건유합강복과정쾌，수술료효호。
Objective To assess the results of a minimally invasive method for reconstructing the lateral ligaments of the ankle using a semitendinosus tendon autograft .Methods From September 2006 to June 2012, 58 patients ( 34 males, 24 females ) with chronic ankle instability underwent the lateral ligament reconstruction by a minimally invasive method with the semitendinosus autograft .The average age was 58.5 ( range, 17 to 62 ) years old.The semitendinosus tendon was harvested through two small incisions at the knee .For the ankle reconstruction , four small incisions of 5 mm each were made at the medial and lateral sides of the fibular tip , the talar neck, and the middle of the calcaneus .The anatomical reconstructions of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) were then performed through these small incisions .The mean follow-up time was (58.5 ±7.4) months, (range, 25 to 86 months ) .AOFAS, VAS questionnaires were used to evaluate the clinical outcomes , donor site morbidity and the patient satisfaction .The preoperative and postoperative stress tests were performed and the radiographic parameters were measured .Results The average opereation time of the autograft group was 75-98 min, (85.5 ±11.5) min in average, and the lasting time of the postoperative fever were 1.5-4 days, (2.5 ±1.2) days in average.In the autograft group, 46 patient were followed up, the follow-up time ranged from 25 to 86 months, (58.5 ±7.4) months in average.The average AOFAS score increased from (62.3 ±8.2) to (95.1 ±7.5) ( P <0.01).Six patients reported the residual instability on the uneven ground .Three patients of the autologous group reported the instability in daily life .No patient reported weakness or disability in the donor site .The satisfaction level of the autograft group was excellent in 31 patients and good in nine patients .Significant improvement of the talar tilt angle according to the stress radiographic parameters was noticed , which showed an average reduction from 14.0 to 3.7 degrees ( P<0.01 ) .The anterior talar displacement reduced from 12.4 to 4.5 mm in average ( P <0.01 ) . Conclusions The reconstruction of the lateral ankle ligaments using a semitendinosus tendon autograft through a minimally invasive approach can achieve a stable ankle while avoiding extensive exposure and the risk of nerve injury .The process of healing and rehabilitation of the autograft tendon is faster and the injury is limit for the patients;the procedure is simple with no donor site morbidity .