摘要目的 探讨踝关节镜下距腓前韧带(ATFL)联合跟腓韧带(CFL)解剖重建治疗慢性踝关节不稳的手术方法及疗效.方法 回顾性分析2012年6月至2016年8月27例(28踝)慢性踝关节不稳患者资料,采用自体半腱肌腱或同种异体肌腱踝关节镜下解剖重建ATFL和CFL,比较患者术前和末次随访时的距骨前移距离、距骨倾斜角、疼痛视觉模拟评分(VAS)及美国足踝外科协会(AOFAS)的踝-后足评分.结果 本组手术时间平均为75.8 min(72~104 min).27例患者术后获平均14.8个月(12~25个月)随访.切口均一期愈合,患者均未出现神经、血管损伤等并发症,无明显踝关节僵硬及活动时疼痛等不良表现.距骨前移距离由术前平均(10.82 ± 3.32)mm减小至末次随访时平均(4.03 ± 1.70)mm,距骨倾斜角由术前平均15.60°± 3.86°减小为末次随访时平均6.01°± 2.64°,VAS评分由术前平均(5.79 ± 1.79)分降至至末次随访时平均(1.54 ± 1.35)分,AOFAS的踝-后足评分由术前平均(63.64 ± 11.20)分提高为末次随访时平均(90.21 ± 4.48)分,差异均有统计学意义(P <0.001).结论 踝关节镜下ATFL联合CFL解剖重建治疗慢性踝关节不稳,可有效改善踝关节功能,提高踝关节稳定性.

abstractsObjective To evaluate the clinical results of arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for treatment of chronic ankle instability. Methods From June 2012 to August 2016, 27 patients with chronic ankle instability (28 ankles) were treated with arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament. All the patients were evaluated preoperatively and at the last follow-up using visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views.Results The operations lasted for 75.8 minutes (from 72 to 104 minutes). The 27 patients received a mean follow-up of 14.8 months (range, from 12 to 25 months). All the wounds healed by the first intention. No neurovascular complications were observed and no patient reported ankle stiffness or pain in motion. On average, the anterior talar trans-lation was reduced from 10.82 ± 3.32 mm preoperatively to 4.03 ± 1.70 mm at the last follow-up, the talar tilt angle decreased from 15.60°± 3.86°to 6.01°± 2.64°, the VAS pain score decreased from 5.79 ± 1.79 to 1.54 ± 1.35, and the AOFAS ankle-hindfoot score improved from 63.64 ± 11.20 to 90.21 ± 4.48. All the above differences were statistically significant (P <0.01). Conclusion Arthroscopic anatomical re-construction of anterior talofibular ligament and calcaneofibular ligament can improve function and stability of the ankle joint effectively, providing a valid option for treatment of chronic ankle instability.