骨科手术早知道012：踝关节外侧韧带重建术（LATERAL ANKLE LIGAMENT RECONSTRUCTION）

      踝关节外侧韧带重建术用于矫正对物理治疗等无效的慢性踝关节不稳。当韧带松弛或断裂时，会发生踝关节不稳。对于需要完全保留活动范围的运动员，人们熟知的如Bröstrum-Gould技术等简单的修补术，是非常理想的。

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Overview（概述）

This procedure is performed to correct chronic ankle instability that has not responded to treatment such as physical therapy. Ankle instability occurs when ligaments are stretched or torn. A simple repair, known as the Bröstrum-Gould technique, is ideal for athletes who need to retain full range of motion.

      本术式用于矫正对物理治疗等无效的慢性踝关节不稳。当韧带松弛或断裂时，会发生踝关节不稳。对于需要完全保留活动范围的运动员，人们熟知的如Bröstrum-Gould技术等简单的修补术，是非常理想的。

Incision（切口）

A small incision is made along the outside of the ankle. The injured lateral ligament (or ligaments) are identified. This example shows a stretched anterior talofibular (ATF) and a torn calcaneofibular (CF) ligament.

      在踝关节外侧作一小切口。辨认受伤的韧带。此例显示距腓前韧带（ATF）松弛和跟腓韧带（CF）撕裂。

Repairing Stretched or Torn Ligaments（修复松弛或撕裂的韧带）

If a ligament was stretched but not torn, it is cut and shortened, then the two ends are sutured together. If a ligament is torn but still attached to the fibula, the ends are repaired and sewn together.

       如果韧带只是松弛而未撕裂，将其切断短缩，两端间相互缝合。如果韧带撕裂但仍与腓骨相连，可将两端修复缝合在一起。

Reattaching Severely Torn Ligaments（修复严重撕裂的韧带）

If the ligament was pull away from the fibula, it must be reattached. sutures can attach the ends of the ligament through a small hole drilled in the fibula.  sutures can also be attached to specail anchors.

      如果韧带受拉离开腓骨，必须重新附着。通过在腓骨上钻小孔可将韧带的末端缝合贴附。还可以通过特殊的锚钉缝合贴附。

Stabilizing the Joint（稳定关节）

The extensor retinaculum-- a bank of tissue that across infront of the ankle joint is use to reinforce the repair. A portion of it is pulled over the repair and suture to the fibula. This also helps to limit inversion of the ankle and correct the instability with the subtalo ankle joint.

      伸肌支持带是跨过踝关节前方的一束组织，可用于加强修复。将其一部分拉到修复面上方，缝合到腓骨上。这样还有助于限制踝关节内翻，矫正踝关节不稳。

End of Procedure/Aftercare（手术结束和术后护理）

Incision is closed with a dissolving stitch under the skin and staler stitch on top of the skin. Plaster splints are applied until swelling has subsided. After a few days, A short leg walking cast is supplied for 3 to 4 weeks, follow by physical therapy. Full activities can be resumed after 10 to 12 weeks. 

      用可吸收线缝合皮下组织，皮肤用皮钉关闭切口。术后数天肿胀消褪前用石膏夹板。随后3～4周使用短腿行走石膏，随后进行物理治疗。术后10～12周可恢复全部活动。

（胡佰文    译）