中华骨与关节外科杂志
中華骨與關節外科雜誌
중화골여관절외과잡지
Chinese Journal Bone and Joint Surgery
2015年
4期
314-319
,共6页
王雪%王成伟%郭鹏超%帕尔哈提%李璐兵
王雪%王成偉%郭鵬超%帕爾哈提%李璐兵
왕설%왕성위%곽붕초%파이합제%리로병
踝关节%外侧副韧带%腓骨长肌%异体肌腱%对比研究
踝關節%外側副韌帶%腓骨長肌%異體肌腱%對比研究
과관절%외측부인대%비골장기%이체기건%대비연구
Ankle%Lateral collateral ligament%Peroneus longus%Allograft tendon%Comparative study
背景:踝关节外侧副韧带(LCAL)损伤的修复包括直接缝合、加强缝合、利用肌腱或替代物重建韧带结构,如Watson-Jones术、Chrisman-Snook手术、改良方式Evans术、Elmslie术等.重建手术目的在于纠正机械不稳定,部分学者采用自体肌腱组织重建韧带,随着经济科技发展,异体组织制备也逐渐完善其功能.目的:比较自体腓骨长肌和同种异体肌腱重建LCAL的临床疗效.方法:回顾性分析2007年6月至2012年6月手术修复陈旧性LCAL损伤引起的慢性外踝不稳的病例资料,其中应用自体腓骨长肌腱重建LCAL 34例,男18例,女16例;年龄15~58岁,平均(30.7±2.1)岁;同期应用深冻同种异体肌腱重LCAL 32例,男17例,女15例;年龄17~63岁,平均(32.4±1.9)岁.两组患者均由同一组高年资主任医师采用Waston-Jones术重建距腓前韧带及跟腓韧带,完成LCAL非解剖重建.术后随访测量腓骨肌反应时间、距骨倾斜角和距骨前移距离,采用视觉模拟标尺法(VAS)评分和美国足踝外科协会(AOFAS))踝-后足功能评分评估疗效.结果:66例患者均获得随访.异体肌腱组的术后发热时间和住院时间明显长于腓骨长肌组[(5.3±1.1)d vs(2.7±0.8)d, (12.2±1.9)d vs(10.3±1.2)d,P<0.05],而手术时间明显短于腓骨长肌组[(61.1±4.3)min vs(87.7±3.9)min,P<0.05].腓骨长肌组末次随访时VAS评分、AOFAS评分、距骨倾斜角、距骨前移距离、腓骨肌反应时间分别为(0.4±0.5)分、(95.1±1.6)分、3.7°±0.9°、(2.2±0.6)mm、(83.1±1.3)ms,与异体肌腱组相比,有显著的统计学差异[(0.6±0.6)分、(96.2± 1.4)分、4.1°±0.8°、(2.3±0.6)mm、(63.9±2.2)ms,P<0.05].结论:同种异体肌腱重建LCAL术后患者踝关节功能、稳定性及运动水平与自体腓骨长肌肌腱重建LCAL临床疗效无统计学差异,是重建LCAL良好的移植物.
揹景:踝關節外側副韌帶(LCAL)損傷的脩複包括直接縫閤、加彊縫閤、利用肌腱或替代物重建韌帶結構,如Watson-Jones術、Chrisman-Snook手術、改良方式Evans術、Elmslie術等.重建手術目的在于糾正機械不穩定,部分學者採用自體肌腱組織重建韌帶,隨著經濟科技髮展,異體組織製備也逐漸完善其功能.目的:比較自體腓骨長肌和同種異體肌腱重建LCAL的臨床療效.方法:迴顧性分析2007年6月至2012年6月手術脩複陳舊性LCAL損傷引起的慢性外踝不穩的病例資料,其中應用自體腓骨長肌腱重建LCAL 34例,男18例,女16例;年齡15~58歲,平均(30.7±2.1)歲;同期應用深凍同種異體肌腱重LCAL 32例,男17例,女15例;年齡17~63歲,平均(32.4±1.9)歲.兩組患者均由同一組高年資主任醫師採用Waston-Jones術重建距腓前韌帶及跟腓韌帶,完成LCAL非解剖重建.術後隨訪測量腓骨肌反應時間、距骨傾斜角和距骨前移距離,採用視覺模擬標呎法(VAS)評分和美國足踝外科協會(AOFAS))踝-後足功能評分評估療效.結果:66例患者均穫得隨訪.異體肌腱組的術後髮熱時間和住院時間明顯長于腓骨長肌組[(5.3±1.1)d vs(2.7±0.8)d, (12.2±1.9)d vs(10.3±1.2)d,P<0.05],而手術時間明顯短于腓骨長肌組[(61.1±4.3)min vs(87.7±3.9)min,P<0.05].腓骨長肌組末次隨訪時VAS評分、AOFAS評分、距骨傾斜角、距骨前移距離、腓骨肌反應時間分彆為(0.4±0.5)分、(95.1±1.6)分、3.7°±0.9°、(2.2±0.6)mm、(83.1±1.3)ms,與異體肌腱組相比,有顯著的統計學差異[(0.6±0.6)分、(96.2± 1.4)分、4.1°±0.8°、(2.3±0.6)mm、(63.9±2.2)ms,P<0.05].結論:同種異體肌腱重建LCAL術後患者踝關節功能、穩定性及運動水平與自體腓骨長肌肌腱重建LCAL臨床療效無統計學差異,是重建LCAL良好的移植物.
배경:과관절외측부인대(LCAL)손상적수복포괄직접봉합、가강봉합、이용기건혹체대물중건인대결구,여Watson-Jones술、Chrisman-Snook수술、개량방식Evans술、Elmslie술등.중건수술목적재우규정궤계불은정,부분학자채용자체기건조직중건인대,수착경제과기발전,이체조직제비야축점완선기공능.목적:비교자체비골장기화동충이체기건중건LCAL적림상료효.방법:회고성분석2007년6월지2012년6월수술수복진구성LCAL손상인기적만성외과불은적병례자료,기중응용자체비골장기건중건LCAL 34례,남18례,녀16례;년령15~58세,평균(30.7±2.1)세;동기응용심동동충이체기건중LCAL 32례,남17례,녀15례;년령17~63세,평균(32.4±1.9)세.량조환자균유동일조고년자주임의사채용Waston-Jones술중건거비전인대급근비인대,완성LCAL비해부중건.술후수방측량비골기반응시간、거골경사각화거골전이거리,채용시각모의표척법(VAS)평분화미국족과외과협회(AOFAS))과-후족공능평분평고료효.결과:66례환자균획득수방.이체기건조적술후발열시간화주원시간명현장우비골장기조[(5.3±1.1)d vs(2.7±0.8)d, (12.2±1.9)d vs(10.3±1.2)d,P<0.05],이수술시간명현단우비골장기조[(61.1±4.3)min vs(87.7±3.9)min,P<0.05].비골장기조말차수방시VAS평분、AOFAS평분、거골경사각、거골전이거리、비골기반응시간분별위(0.4±0.5)분、(95.1±1.6)분、3.7°±0.9°、(2.2±0.6)mm、(83.1±1.3)ms,여이체기건조상비,유현저적통계학차이[(0.6±0.6)분、(96.2± 1.4)분、4.1°±0.8°、(2.3±0.6)mm、(63.9±2.2)ms,P<0.05].결론:동충이체기건중건LCAL술후환자과관절공능、은정성급운동수평여자체비골장기기건중건LCAL림상료효무통계학차이,시중건LCAL량호적이식물.
Background:The repair for lateral collateral ankle ligament (LCAL) injuries includes direct suture, strengthened suture, the use of tendon or substitute reconstruction of ligament structure, such as Watson-Jones, Chrisman-Snook, improved Evans, Elmslie surgery. The purpose of reconstruction is to correct mechanical instability. Autologous tendon has been used for re-construction ligament. Along with the development of science and technology, foreign organization preparation has been gradually improved. Objective:To compare clinical outcomes between autologous peroneus longus tendon (PLT) and allogenic tendon (AT) in re-constructing LCAL. Methods:Clinical data of 66 patients with chronic external ankle instability caused by LCAL trauma who underwent LCAL reconstruction between June 2007 and 2012 were retrospectively analyzed. Autologous PLT was used in 34 patients (PLT group) and AT was used in 32 patients (AT group). In the PLT group, there were 18 males and 16 females with an average age of (30.7 ± 2.1) years (range, 15-58 years). In the AT group, there were 17 males and 15 females with an average age of (32.4±1.9) years (range, 17-63 years). Waston-Jones surgery was performed to reconstruct anterior talofibular ligament and calcaneofibular ligament by the same team of surgeons. Peroneus longus reaction time, talar tilt angle and the distance of an-terior talar displacement were measured during follow-up. The VAS score and AOFAS score were recorded.Results:All the 66 patients were followed up. Postoperative fever duration and hospital stay in the AT group were signifi-cantly longer than those in the PLT group ([5.3±1.1]d vs [2.7±0.8]d, [12.2±1.9] d vs [10.3±1.2]d, P<0.05), while operation time in the AT group were significantly shorter than that in the PLT group ([61.1 ± 4.3]min vs [87.7 ± 3.9]min, P<0.05). The VAS score, AOFAS score, talar tilt angle, the distance of anterior talar displacement and peroneus longus reaction time at the final follow-up were 0.4±0.5, 95.1±1.6, 3.7°±0.9°, (2.2±0.6) mm, (83.1±1.3) ms in the PLT group, which were signifi-cantly different from those in the AT group (0.6±0.6, 96.2±1.4, 4.1°±0.8°, [2.3±0.6]mm, [63.9±2.2]ms, P<0.05). Conclusions:Allogenic tendon is a good graft for LCAL reconstruction. There are no significant differences in postoperative ankle function, stability or activity levels between patient undergoing LCAL reconstruction with autologous peroneus lon-gus tendon versus allogenic tendon.
