| Objective: This article comparesed the efficacy of three surgical methods by autologous ligament suture, autologous peroneus brevis tendon reconstruction and tendon allograft reconstruction methods to treated CLAI, and summed reasonable surgical treat method.Methods: To retrospectivly analysis 45(21 male, 24 female) CLAI patients of the Third Hospital of Hebei Medical University, foot and ankle department, from January 2013 to December 2014, 35 patients(18 male, 17 female)were followed up, aged 12 years to 58 years, average(33.99±12.441) years old. Patients was divided into three groups according to the surgical procedures: A was autologous ligament suture group(the modified Brostr?m method), a total of 12 cases; B was autologous peroneus brevis reconstruction group(the Larsen method), a total of 13 cases; C was tendon allograft reconstruction group, a total of 10 cases. All surgeries were performed by the same experienced physician completed. To record the anterior talar translation(ATT) and the talus varus angle(TTA) before surgery, 3 months and 1 year after surgery. To record the AOFAS ankle-hindfoot scores, Karlsson-Peterson scores before surgery and one year after surgery. To record Sefton joint stability classification and good rate one year after surgery.The above data were statistically analyzed and compared.Results: All 35 patients were followed up after operation, and follow-up period was one year after operation.1 A group of autologous ligament suture, B group of autologous peroneus brevis reconstruction, C group of tendon allograft reconstruction in terms of imaging: the ATT(mm) were 6.85±1.327, 7.04±1.155, 7.00±1.046 preoperatively; 3 months after operation were 3.63±0.561, 3.03±0.871, 2.81±0.737; 1 year after operation were 3.44±0.617, 2.83±0.840, 2.67±0.748. The TTA(o) preoperatively were 12.44±1.581, 12.66±1.229, 12.87±0.831; 3 months after operation were 4.43±0.923, 3.85±0.529, 3.67±0.377; 1 year after operation were 4.32±0.989, 3.67±0.680, 3.52±0.352. In terms of the above two measures, A, B, C each group result between preoperation and postoperation 1-year were significantly different(P < 0.05), applicating pairwise t test to compare the method.A, B, C three groups before surgery were no significant difference between the results of each group applicating pairwise t test to compare the methods; the results of A, B, C three groups one year after surgery that were significantly different(P<0.05) between the group A and group B, group A and group C, and no significant difference between group B and group C(P>0.05).2 A group of autologous ligament suture, B group of autologous peroneus brevis reconstruction, C group of tendon allograft reconstruction in terms of score: AOFAS ankle-hindfoot scores preoprativly were 45.91±5.230, 43.77±3.789, 43.20±1.989; after 1 year were 86.33±3.576, 89.85±2.340, 90.90±2.331. Respectively, Karlsson-Peterson scores preoprativly were 41.75±5.691, 40.84±3.997, 39.90±2.727; after one year were 87.58±2.811, 91.23±1.878, 91.00±2.108. In terms of the above two measures, A, B, C each group result between preoperation and postoperation 1-year were significantly different(P<0.05), applicating pairwise t test to compare the method.A, B, C three groups before surgery were no significant difference between the results of each group applicating pairwise t test to compare the methods; the results of A, B, C three groups one year after surgery that were significantly different(P <0.05) between the group A and group B, group A and group C, and no significant difference between group B and group C(P>0.05).3 To applicate Sefton joint stability classification assessed the results 1 year after suegery. Group A of autologous ligament suture were 2 cases of 1, 5 cases of 2, 4 cases of 3, 1 cases of 4, and steady rate was 58.3%; group B of autologous peroneus brevis reconstruction group were 2 cases of 1, 8 cases of 2, 3 cases of 3, 0 cases of 4, and steady rate was 76.9%; group C of tendon allograft reconstruction were 3 cases of 1, 6 cases of 2, 1 cases of 3, 0 cases of 4, and steady rate was 90.0%. One year after surgery, applying rank sum test method to compare steady rate of A, B, C three groups were no significant difference(X2 = 2.582, P = 0.275> 0.05).4 To applicate excellent rate assessed the results 1 year after suegery. Group A of autologous ligament suture were 3 cases of excellent, 6 cases of good, 2 cases of fair, 1 cases of poor, and excellent rate was 75.0%; group B of autologous peroneus brevis reconstruction were 2 cases of excellent, 8 cases of good, 3 cases of fair, 0 cases of poor, and excellent rate is 84.6%; group C of tendon allograft reconstruction were 4 cases of excellent, 5 cases of good, 1 cases of fair, 0 cases of poor, and excellent rate was 90.0%. One year after surgery, applying rank sum test method to compare excellent rate of A, B, C three groups were no significant difference(X2 = 2.582, P = 0.275> 0.05).5 In complications, group A were 1 cases(1 ankle) occurred in instability, no wound infection. Group B was 1 case(1 ankle) occurred in stiff ankle, no wound infection. Group C were 2 patients(2 ankles) occurred in ankle stiffness, 1 case(1 ankle) occurred in incision redness and healing after antibiotic therapy.Conclusions:1 Three surgical methods of autologous ligament suture, autologous peroneus brevis reconstruction and tendon allograft reconstruction all could effectively treat CLAI.2 Since surgical procedures of autologous peroneus brevis reconstruction and tendon allograft reconstruction were better than autologous ligament suture, patients could better restore the stability of the ankle joint, better able to improve the quality of life after surgery, so the patients satisfaction were high.3 Although the reconstruction methods of autologous peroneus brevis tendon and tendon allograft the effect were good, but these two surgical methods relatively were majior trauma. The tendon allograft was suitable for youth and middle-aged patients because expensive. However autologous ligament suture were minor trauma, processed short, low cost. After all, autologous ligament suture was a preferred surgical method choice of the elderly and young people. |
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