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前距腓韧带修复术治疗踝关节外侧不稳定疗效分析
Effectiveness of anterior talofibular ligament repair in treatment of lateral ankle stability
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陈守勃,华英汇
- , 2017, DOI: 10.7507/1002-1892.201611022
Abstract: 目的 探讨前距腓韧带修复术治疗踝关节外侧不稳定的临床疗效及合并跗骨窦综合征对疗效的影响。 方法 回顾分析 2013 年 12 月—2014 年 10 月,采用前距腓韧带修复术治疗的 47 例踝关节外侧不稳定患者临床资料。其中,32 例未合并跗骨窦综合征(A 组);15 例合并跗骨窦综合征(B 组),同时行跗骨窦清理术。两组患者性别、年龄、病程、侧别以及术前美国矫形足踝协会(AOFAS)评分、Karlsson 评分、Tegner 运动功能评分等一般资料比较,差异均无统计学意义( P>0.05),具有可比性。 结果 两组切口均Ⅰ期愈合,无早期手术相关并发症发生。患者均获随访,A 组随访时间 20~31 个月,平均 26.0 个月;B 组随访时间 20~31 个月,平均 24.7 个月。所有患者踝关节肿胀均消失,关节活动良好,恢复正常行走。末次随访时,两组 AOFAS 评分、Karlsson 评分、Tegner 运动功能评分均较术前明显提高,差异有统计学意义( P<0.05);组间比较差异无统计学意义( P>0.05)。随访期间无踝关节不稳复发。 结论 无论是否合并跗骨窦综合征,前距腓韧带修复术治疗踝关节外侧不稳定均能获得满意疗效。
Objective To evaluate the effectiveness of anterior talofibular ligament repair in the treatment of lateral ankle stability and the effect of combined tarsal sinus syndrome on results. Methods Between December 2013 and October 2014, 47 cases of lateral ankle instability underwent anatomical repair of anterior talofibular ligament, and the clinical data were retrospectively analyzed. Of 47 cases, 32 had no tarsal sinus syndrome (group A); 15 had tarsal sinus syndrome (group B), arthroscopic debridement of tarsal sinus was performed at the same time. There was no significant difference in gender, age, disease duration, side, American Orthopaedic Foot and Ankle Society (AOFAS), Karlsson score, and Tegner movement function score between 2 groups ( P>0.05). Results No early surgical complication of infection occurred, and primary healing of incision was obtained in 2 groups. The patients were followed up 20-31 months (mean, 26.0 months) in group A, and 20-31 months (mean, 24.7 months) in group B. Disappearance of ankle swelling, good joints movement, and recovery of normal walking were observed in all patients. At last follow-up, AOFAS score, Karlsson score, and Tegner movement function score were significantly improved when compared with preoperative ones in 2 groups ( P<0.05), but no significant difference was found between 2 groups ( P>0.05). No ankle instability recurrence was found during follow-up period. Conclusion The effectiveness of anatomical repair of anterior talofibular ligament in lateral ankle instability is satisfactory for patients with or without tarsal sinus syndrome.
The diagnosis and treatment of deltoid ligament lesions in supination–external rotation ankle fractures: a review
Sjoerd A. S. Stufkens,Michel P. J. van den Bekerom,Markus Knupp,Beat Hintermann,C. Niek van Dijk
Strategies in Trauma and Limb Reconstruction , 2012, DOI: 10.1007/s11751-012-0140-9
Abstract: The supination–external rotation or Weber B type fracture exists as a stable and an unstable type. The unstable type has a medial malleolus fracture or deltoid ligament lesion in addition to a fibular fracture. The consensus is the unstable type and best treated by open reduction and internal fixation. The diagnostic process for a medial ligament lesion has been well investigated but there is no consensus as to the best method of assessment. The number of deltoid ruptures as a result of an external rotation mechanism is higher than previously believed. The derivation of the injury mechanism could provide information of the likely ligamentous lesion in several fracture patterns. The use of the Lauge-Hansen classification system in the assessment of the initial X-ray images can be helpful in predicting the involvement of the deltoid ligament but the reliability in terms of sensitivity and specificity is unknown. Clinical examination, stress radiography, magnetic resonance imaging, arthroscopy, and ultrasonography have been used to investigate medial collateral integrity in cases of ankle fractures. None of these has shown to possess the combination of being cost-effective, reliable and easy to use; currently gravity stress radiography is favoured and, in cases of doubt, arthroscopy could be of value. There is a disagreement as to the benefit of repair by suture of the deltoid ligament in cases of an acute rupture in combination with a lateral malleolar fracture. There is no evidence found for suturing but exploration is thought to be beneficial in case of interposition of medial structures.
THE VALUE OF THE ARTHROSCOPY IN ACUTE AND CHRONIC ANKLE INJURY
B. Voicu,R. Opri?
Jurnalul de Chirurgie , 2010,
Abstract: This paper wants to demonstrate the value of the arthroscopy in the diagnosis and treatment of the ankle sprain and cronic ankle instability. Between January 2005 and March 2009, there were studied 25 patients, to whom there was made ankle arthroscopy with the purpose to diagnose and the treatment. The mean age was 26 years, with a range from 19 to 42 years, 19 from them were men and 6 women. The final evaluation was made to 23 patient, with a medium six month follow-up. The functional results after arthroscopy were evaluate using Mc Cullough Score. In 78% of cases the pain disapeared significantly. There was made in all cases debridation with shaver, in 12 cases microabrasive chondroplasty and in 7 cases ligamentoplasty of the anterior talofibular ligament and/or deltoid ligament. In 76% there was, at least an associated, hiden”, lesion, wich need also arthroscopic treatment. We have one complication (4,3%) represented by a superficial chondral lesion, wich was treated by microabrasive chondroplasty. There were any neurological, vascular or other complications. The results show us that ankle arthroscopy remain a certain, mini-invazive method to diagnose and for the treatment of the ankle lesions. Arthroscopic ligamentoplasty of the ankle is still in confirmation. Arthrocopy is the main procedure for treating the impingement syndrom of the ankle and osteochondral lesion – injury that are frecventely associated with chronic ankle instability.
Combined Posterior and Anterior Ankle Arthroscopy
Peter E. Scholten,C. Niek van Dijk
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/693124
Abstract: Treatment of combined anterior and posterior ankle pathology usually consists of either combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with the extensive exposure, the latter technique provides limited access to the posterior ankle joint. A case is described of combined anterior and posterior arthroscopy, with the patient lying prone and then turned supine, addressing both anterior and posterior ankle pathologies in one tempo. This minimally invasive combined approach allows quick recovery and early return to work and sports activities.
Combined Posterior and Anterior Ankle Arthroscopy  [PDF]
Peter E. Scholten,C. Niek van Dijk
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/693124
Abstract: Treatment of combined anterior and posterior ankle pathology usually consists of either combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with the extensive exposure, the latter technique provides limited access to the posterior ankle joint. A case is described of combined anterior and posterior arthroscopy, with the patient lying prone and then turned supine, addressing both anterior and posterior ankle pathologies in one tempo. This minimally invasive combined approach allows quick recovery and early return to work and sports activities. 1. Introduction In the early days of the orthopaedic era the ankle joint was regarded unsuitable for arthroscopy because of its typical anatomy [1]. Nowadays it is an established treatment of choice for most ankle pathologies. Routinely, anteromedial and anterolateral portals are used. An additional posterolateral portal has been advocated in cases of posterior ankle pathology, but it has usually been viewed as an accessory rather than the main working portal [2]. Arthroscopic procedures which are performed using this portal are not easy [3]. The use of a 2-portal endoscopic approach to the posterior ankle with the patient in the prone position gives excellent access for the examination and treatment of posterior ankle pathology [4]. When both posterior and anterior ankle pathology coexist, the surgeon may consider an open anterior and posterior arthrotomy. An open approach by both anterior and posterior incisions has an increased risk of complications and a prolonged rehabilitation period. An anterior arthroscopic approach with an accessory posterior portal, will give good access to the anterior joint, but compromises access to the posterior joint. This paper describes a patient with combined anterior and posterior ankle pathology, admitted to the coauthors hospital. A combined posterior and anterior arthroscopic approach was used, initially with the patient prone for the posterior arthroscopic procedure and then turned supine for the anterior arthroscopic procedure, both in the same surgical session. This combined arthroscopic approach gives excellent access to both the anterior and posterior aspects of the ankle. 2. Patient and Methods A 21-year-old professional soccer player, who was operated for a medial malleolar fracture of his right ankle 10 years before, developed pain and swelling of the medial side of his right ankle. He was diagnosed as having a flexor hallucis longus (FHL)
Pseudoaneurysm as a complication of ankle arthroscopy  [cached]
Brimmo Olubusola,Parekh Selene
Indian Journal of Orthopaedics , 2010,
Abstract: We present a case of a pseudoaneurysm of the anterior tibial artery following ankle arthroscopy with synovectomy, an extremely rare complication when standard anteromedial and anterolateral portals are used. The patient was diagnosed and treated with appropriate interventions which led to an uneventful recovery. Nevertheless, the potential sequelae of delayed diagnosis or misdiagnosis of the complication are dangerous; therefore, a high index of suspicion for a pseudoaneurysm must be maintained in the postoperative period.
Ankle ligament injuries
Renstr?m, Per A.F.H.;Lynch, Scott A.;
Revista Brasileira de Medicina do Esporte , 1998, DOI: 10.1590/S1517-86921998000300002
Abstract: acute ankle ligament sprains are common injuries. the majority of these occur during athletic participation in the 15 to 35 year age range. despite the frequency of the injury, diagnostic and treatment protocols have varied greatly. lateral ligament complex injuries are by far the most common of the ankle sprains. lateral ligament injuries typically occur during plantar flexion and inversion, which is the position of maximum stress on the anterotalofibular liagment (atfl). for this reason, the atfl is the most commonly torn ligament during an inversion injury. in more severe inversion injuries the calcaneofibular (cfl), posterotalofibular (ptfl) and subtalar ligament can also be injured. most acute lateral ankle ligament injuries recover quickly with nonoperative management. the treatment program, called "functional treatment," includes application of the rice principle (rest, ice, compression, and elevation) immediately after the injury, a short period of immobilization and protection with an elastic or inelastic tape or bandage, and early motion exercises followed by early weight bearing and neuromuscular ankle training. proprioceptive training with a tilt board is commenced as soon as possible, usually after 3 to 4 weeks. the purpose is to improve the balance and neuromuscular control of the ankle. sequelae after ankle ligament injuries are very common. as much as 10% to 30% of patients with a lateral ligament injury may have chronic symptoms. symptoms usually include persistent synovitis or tendinitis, ankle stiffness, swelling, and pain, muscle weakness, and frequent giving-way. a well designed physical therapy program with peroneal strengthening and proprioceptive training, along with bracing and/or taping can alleviate instability problems in most patients. for cases of chronic instability that are refractory to bracing and external support, surgical treatment can be explored. if the chronic instability is associated with subtalar instability that is refracto
慢性踝关节外侧不稳的解剖修复治疗进展
ADVANCES IN ANATOMICAL REPAIR OF CHRONIC LATERAL ANKLE INSTABILITY
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张言,梁晓军
- , 2016, DOI: 10.7507/1002-1892.20160319
Abstract: 目的总结目前慢性踝关节外侧不稳(chronic lateral ankle instability,CLAI)的解剖修复治疗研究现状及进展。 方法查阅国内外关于CLAI的解剖修复治疗的文献,并进行分析整理和总结。 结果目前CLAI解剖修复术式主要为Brostr?m术及其改良术式,此类术式操作简便,近、中、远期随访均显示满意临床疗效,且并发症发生率低。目前,带线锚钉技术、关节镜技术均逐渐用于Brostr?m术及其改良术式中,并能获得较好近期疗效,远期疗效有待进一步观察。 结论Brostr?m术及其改良术式是治疗CLAI有效、便捷、安全方法。在生物力学和动态解剖学研究基础上进行个性化修复方案设计是进一步研究方向。
ObjectiveTo summarize the current status and progress of the treatment of chronic lateral ankle instability (CLAI). MethodsThe literature about the anatomical repair of CLAI at home and abroad was reviewed and summarized. ResultsBrostr?m and its modified operations are the most common surgical treatment of CLAI. The operations showed satisfactory clinical outcomes in the short-, medium-, and long-term follow-up and low complication rate. Suture anchor technique and arthroscopic techniques are gradually used in Brostr?m and its modified operations with satisfactory short-term effectiveness, but long-term effectiveness needs further observation because of the limitation of the short clinical application time. ConclusionBrostr?m and its modified operations are effective, convenient, and safe to treat CLAI. Based on the researches of biomechanics and dynamic anatomy, the more personalized design of the rehabilitation program is the further research direction.
Chondrolysis of the Ankle Joint following Ankle Arthroscopy and Microfracture of the Osteochondral Lesion of the Talar Dome  [PDF]
Tsz Lung Choi,Tun Hing Lui
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/908082
Abstract: Chondrolysis of the ankle is a very rare condition. We report a case of chondrolysis of the ankle following ankle arthroscopy and microfracture of the osteochondral lesion of the talar dome. The patient’s symptoms were relieved after articulated distraction arthroplasty. 1. Introduction Chondrolysis is a clinical condition characterized by rapid destruction of articular cartilage on both sides of the joint leading to loss of joint space and joint stiffness. The cause has not truly been identified [1]. Chondrolysis has most commonly been described in the hip, shoulder, and knee joints. There were three cases of chondrolysis of the ankle joint reported in the English literature [1–3]. We report a case of chondrolysis of the ankle following ankle arthroscopy and microfracture of the osteochondral lesion of the talar dome. 2. Case Report A 32-year-old gentleman had inversion injury to his left ankle on 2007 resulting in persistent medial ankle pain. He was treated with physiotherapy without improvement. Radiographs and magnetic resonance imaging (MRI) of his left ankle showed the presence of osteochondral lesion (OCL) of the medial talar dome (Figure 1). Ankle arthroscopy and microfracture of the osteochondral lesion were performed on May 2008. His left ankle pain persisted after the operation and MRI of his left ankle was repeated and showed no interval change as compared to the previous MRI. Ankle arthroscopy was repeated on March 2009. Intraoperative findings showed that the medial talar OCL was covered with fibrocartilage and the other articular cartilage of the ankle joint was normal. However, his left ankle pain deteriorated afterwards as that he needed to walk with crutches. He complained of medial ankle pain and there was no rest pain or systemic upset. He was referred to our clinic for further management. Clinical examination showed that his left ankle was stiff with tenderness at the medial talar dome. Standing radiographs and MRI of his left ankle showed decreased ankle joint space without significant osteophytes formation, subchondral cyst, or subchondral sclerosis (Figure 2). Blood tests and gallium scan did not suggest any underlying infection. Ankle arthroscopy and distraction arthroplasty with Universal Compress Hinge were performed on May 2010. Arthroscopic findings showed marked fibrosis of the capsule with minimal synovitis. Most of the articular cartilage of the ankle joint was gone with exposure of the subchondral bone. There was an osseous defect at the medial talar dome. The patient was advised on active ankle mobilization exercise
踝关节骨折合并急性三角韧带损伤的诊断和治疗进展
Progress of diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury
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张云,杨云峰
- , 2017, DOI: 10.7507/1002-1892.201701053
Abstract: 目的 综述踝关节骨折合并急性三角韧带损伤的诊断和治疗进展,为临床治疗提供参考。 方法 广泛查阅国内外有关踝关节骨折合并急性三角韧带损伤诊断及治疗的文献,并进行总结分析。 结果 踝关节骨折合并急性三角韧带损伤容易漏诊,需要结合患者主诉、体征及影像学检查诊断,必要时手术探查明确。稳定骨折后是否需要修补三角韧带仍存在争议。 结论 三角韧带是稳定内侧踝关节的重要结构,对于不同类型踝关节骨折合并急性三角韧带损伤的治疗仍需进一步标准化,并根据术中踝关节稳定情况决定是否修补。
Objective To review the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury. Methods Recent literature concerning the diagnosis and treatment of ankle fractures combined with acute deltoid ligament injury was reviewed. Results Misdiagnosis is common for ankle fractures combined with acute deltoid ligament injury. A diagnosis is given based on patients’ complaints, symptoms, and imaging examination, even surgical exploration is necessary. Whether to repair the deltoid ligament remains controversial. Conclusion Deltoid ligament is an important structure to stabilize the medial ankle joint. However, treatment of different kinds of ankle fractures combined with acute deltoid ligament injury should be standardized; whether or not repair deltoid ligament is determined by the intraoperative ankle stability.
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