摘要目的 探讨腓骨肌腱上支持带(superior peroneal retinaculum,SPR)止点重建术治疗复发性腓骨肌腱脱位的临床疗效.方法 回顾性分析2012年12月至2017年6月接受SPR止点重建术的24例复发性腓骨肌腱脱位患者,男20例,女4例;年龄(24.9±9.3)岁(范围14~48岁);体重指数(23.18±3.50)kg/m(2 范围15.8~32.2 kg/m2).以腓骨远端最高点后缘为中心取4~5 cm弧形切口,显露后可见SPR与外踝表面骨膜相连,与深层骨质分离,形成假囊.探查腓骨长短肌腱有无撕裂,切除假囊,骨面新鲜化,用两枚带线锚钉将SPR缝合固定于骨面,骨膜与SPR重叠缝合.术后随访时评估美国足踝外科学会(American Orthopaedic Foot and Ankle Society,AOFAS)后足与踝评分、疼痛视觉模拟评分(visual analogue scale,VAS)、重返运动时间、重返伤前运动水平的患者比例、并发症发生率及患者主观满意度.结果 24例患者均顺利完成手术,手术切口均Ⅰ期愈合.手术时间为(36.1±8.8)min(范围20~51 min),术中失血量为(4.1±2.7)m(l 范围1~10 ml).22例完成随访,随访时间(33.9±15.7)个月(范围13~61个月).末次随访时,AOFAS评分(95.5±4.3)分(范围86~100分),高于术前的(77.8±7.8)分(范围58~90分),差异有统计学意义(t=-11.89,P<0.001);VAS评分(0.3±0.8)分(范围0~3分),较术前的(4.2±2.4)分(范围0~8分)明显降低,差异有统计学意义(t=7.69,P<0.001).20例(91%,20/22)重返伤前运动水平,重返运动时间(5.0±1.9)个月(范围3~10个月).1例(5%,1/22)踝关节背伸活动度受限,2例(9%,2/22)出现术区轻度疼痛.随访期间所有患者均无腓骨肌腱脱位复发,主观满意优良率91%(20/22).结论 SPR止点重建术治疗腓骨肌腱复发性脱位创伤小,重返运动比例较高,术后早中期疗效优良.

abstractsObjective To investigate clinical outcomes of modified reattachment of superior peroneal retinaculum (SPR) for patients with recurrent peroneal tendon dislocation. Methods A total of 24 cases with recurrent peroneal tendon dislocation from December 2012 to June 2017 were treated with modified reattachment of SPR. There were 20 males and 4 females. The aver?age age was 24.9±9.3 years (14-48 years). The average BMI was 23.18±3.50 kg/m2 (15.8-32.2 kg/m2). A 4-5 cm incision was made along the lateral margin of the fibula and curved distally around the fibular tip in line with the peroneal excursion. The supe?rior peroneal retinaculum, peroneus longus and peroneus brevis were exposed. The periosteum and SPR were stripped from the fib?ula. The false pouch was formed. Two suture anchors were inserted into the postero?lateral ridge of the lateral malleolus without damaging the cartilaginous ridge, after which the SPR was reattached to the lateral malleolus with the anchored suture. The inner layer of the false pouch was incised, while the outer layer (periosteum) was sutured with the SPR in a pants?over?vest style. The fol?lowing items, including American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), rate of return to previous sports level, time to return to sports activity, complication, and patients satisfaction were evaluated preoperatively and at the final follow?up. Results The average operation duration was 36.1±8.8 min (20-51 min). The blood loss was 1-10 ml, aver?age 4.1±2.7 ml. The follow?up was carried out in 22 cases for mean 33.9±15.7 months (13-61 months). AOFAS score was im?proved from 77.8±7.8 points to 95.5±4.3 points significantly (t=-11.89, P<0.001). VAS score was reduced from 4.2±2.4 to 0.3±0.8 significantly (t=7.69, P<0.001). Mean duration return to sports activity was 5.0±1.9 months (3-10 months). A total of 20 patients (91%) returned to their previous sports level. Only one patient (5%) was found with limitation of range of motion, while two patients (9%) reported pain at the scar site without recurrence. The satisfaction rate was 91%. Conclusion Clinical outcomes of modified reattachment of SPR for patients with recurrent peroneal tendon dislocation was safe and effective.