踝关节慢性前外侧不稳的手术治疗

目的: 探讨治疗踝关节慢性前外侧不稳定 (踝关节外侧不稳定合并距下关节不稳定) 的合理而有效的手术方式。方法: 自 1999 ~2003年, 应用Chrisman Snook术式, 以腓骨短肌腱前半部分重建距腓前韧带、跟腓韧带和距跟外侧韧带,治疗踝关节慢性前外侧不稳 8例患者,共 13例关节。结果: 术后随诊 6个月~5年, 平均 19个月。术后所有踝关节均达到功能稳定, 关节活动度基本恢复正常, 没有复发性踝关节不稳发生。以Good评级标准作为疗效评价, 10例关节 (77% ) 为优, 2例关节 (15% ) 为良, 1例关节为中 (7% ), 优良率达 92%。结论: Chrisman Snook术式重建了距腓前韧带、跟腓韧带和距跟外侧韧带, 有效地矫正了踝关节外侧不稳定和距下关节不稳定, 是治疗踝关节慢性前外侧严重不稳定的合理而有效的治疗方法。

Surgical treatment for chronic anterolateral ankle instability

Objective: To discuss a reasonable and effective surgical method for the treatment of chronic anterolateral ankle instability (lateral instability accompanied with subtalar instability). Method: From 1999 to 2003, Christman Snook technique was used for surgical treatment of chronic anterolateral ankle instability in 8 patients with 13 ankle joints, in which the anterior talofibular, calcaniofibular and lateral talocalcaneal ligaments were reconstructed using anterior half of peroneus brevis tendon. Result: Postoperative follow up was from half to five years, with 19 months in average. Functional stability was achieved and range of motion was generally recovered without recurrent instability. The therapeutic results were evaluated with grading scale developed by Good et al. Ten joints (77%) were excellent, two (15%) were good, and one (7%) was fair. The satisfactory rate reached to 92%. Conclusion: With Christman Snook technique, anterior talofibular, calcaniofibular and lateral talocalcaneal ligaments can all be reconstructed, so that both lateral and subtalar instability of ankle can be stabilized effectively. It is a reasonable and effective surgical method for the treatment of chronic anterolateral ankle instability.