PDF(Pubmed)
Abstract：
Background A combined reconstruction of chronic deltoid and spring ligament insufficiency is uncommon. Our study aims to share our experience in treating post-traumatic, chronic deltoid, and spring ligament insufficiency using the \"quadrangular construct\" technique. Material and methods Five patients who had post-traumatic combined deltoid and spring ligament insufficiency were included in the study. All patients reported a \"giving-way\" sensation. Preoperatively, each patient underwent weight-bearing radiographs of the ankle and foot. The talo-first metatarsal angle and hindfoot alignment angle were noted. The superficial deltoid ligament was repaired using a suture anchor augmented with Internal BraceTM (Arthrex, Naples, USA) FiberTape® to form a quadrangular construct that anatomically mimics various components of the deltoid-spring ligament complex. Due to the associated excessive heel valgus, three patients also underwent medial displacement calcaneum osteotomy. Additionally, one patient required lateral ligament repair, and another patient required syndesmotic stabilization. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used to evaluate preoperative and postoperative ankle function. Results All five patients were followed up for a mean of 20 months (range: 12-24 months). The mean preoperative talo-first metatarsal angle improved from 8.46 degrees to 4.84 degrees. The preoperative mean hindfoot alignment angle was reduced from 10.9 to 5.76 degrees postoperatively. One patient had irritation due to the anchor, which needed removal after one year. Postoperatively, no patients re-experienced the feeling of \"giving way\". The AOFAS scores postoperatively showed two patients as excellent, two as good, and one as fair. All the patients returned to their pre-injury work. Conclusion We have developed a technique for combined deltoid and spring ligament reconstruction using a quadrangular construct. This technique helps to restore anatomical stability, is safe, easily reproducible, and has shown positive short-term results in follow-up. The level of evidence is one of the methods used to categorize the quality and reliability of research, and our study falls under the category of level IV evidence.
摘要：
背景慢性三角肌和弹簧韧带功能不全的联合重建并不常见。我们的研究旨在分享我们在治疗创伤后，慢性三角肌,和使用“四边形结构”技术的弹簧韧带功能不全。材料和方法本研究包括5例创伤后合并三角肌和弹簧韧带功能不全的患者。所有患者都报告了“让路”的感觉。术前,每位患者均接受踝关节和足部负重X线照片.注意到足第一跖骨角和后足对齐角。使用内部BraceTM增强的缝合锚钉修复了浅三角肌韧带（Arthrex，那不勒斯,美国）FiberTape®形成四边形结构，在解剖学上模仿三角肌-弹簧韧带复合体的各种组成部分。由于相关的过多的脚跟外翻，3例患者还接受了内侧移位跟骨截骨术。此外,一名患者需要外侧韧带修复,和另一个病人需要的联合稳定。美国骨科足踝协会（AOFAS）后足评分用于评估术前和术后的踝关节功能。结果5例患者均获随访,随访时间12～24个月,平均20个月。术前平均距骨第一跖骨角从8.46度改善至4.84度。术前平均后足对齐角度从术后的10.9度减小到5.76度。一名患者由于锚而感到不适，一年后需要移除。术后,没有病人重新体验到“让路”的感觉。术后AOFAS评分显示两名患者为优秀，两个一样好，一个公平。所有患者都恢复了受伤前的工作。结论我们开发了一种使用四边形结构进行三角肌和弹簧韧带联合重建的技术。这种技术有助于恢复解剖稳定性，是安全的,易于重现，并在后续行动中显示出积极的短期结果。证据水平是对研究质量和可靠性进行分类的方法之一，我们的研究属于IV级证据.
