Ankle instability_ repetitive sprained _82442

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Ankle instability_ repetitive sprained _82442 Powered By Docstoc
					?Ankle instability, repetitive


In acute injury, about 20-40 per cent of patients appear long
repeated inability, sprained ankle, especially walking on uneven
ground, patients often feel lost control of the ankle, Varus. Sprain
can be accompanied or not accompanied by pain, swelling. Some
patients may feel stiff ankle. At this point, that is, entering the
stage of chronic instability. The patient can be mechanical
instability, but functional instability. The former refers to
patients with symptoms of instability, while ankle over normal
physiological range; the second refers to the ankle and no more than
normal physiological range, but in a long time after, ankle often
appear to play soft, walking on uneven roads when repetitive strain
and other symptoms. Ankle functional instability, the patient on the
ankle of subjective control capacity reduction, but the ankle does
not exceed the normal physiological range. In chronic instability,
you can be a mechanical instability or functional instability.
Lateral ankle ligament rupture relaxation is the mechanical
instability of the main reasons. Functional instability and a lot of
factors. Such as: joint capsule and ligaments after nerve damage in
sensors, proprioception obstacles occurred, causing the body's
movement and reflection controls, resulting in the ankle joint.
Others, such as the fibula muscle weakness, subtalar instability is a
common cause. Jiangsu provincial hospital orthopedics du-Pin

(2) treatment

1. non-surgical treatment

Treatment of functional instability, mainly by the peroneal muscular
strength training, Achilles tendon strain, ankle balance sheet and
balance disc exercises are composed of rehabilitation exercises.
Training time should not be less than 10 weeks. In addition, the use
of bandages and splint fixation can reduce excessive activity of the
ankle, increase the stability of the ankle. But Rarick report: the
use of adhesive plaster fixation, in activity after 10 minutes, 50
per cent of its strength reduced. Freman reported after
rehabilitation training, 70-85% of functional instability can get
good results.

2. surgery

On the mechanical instability of patients should also be functional
rehabilitation training, such as non-operation fails, you can
consider surgery.

Surgical methods can be divided into two categories:

(1) the anatomy of the repair method. 1966 Lennart Brostrom doctor
first reported the anatomy of the repair method. About faults in the
space before ligament ligament (the space before the Peroneal Tendon)
and with ligament ligament (with ligament ligament) directly stitched
or stitching to the lateral malleolus, used for the treatment of
lateral ankle ligament injuries. 1980 Gould on Nathaniel Brostrom
operative method to do the upgrade, the extensor retinaculum lateral
portion of the dorsal TIRA stitched to the distal tibia and fibula,
further enhancing the power of the ligament repair, after this
operation is commonly called improvement Brostrom-Gould surgery.

Anatomy of the fix benefits of lateral ligament is not at the expense
of their own organization, in the absence of tendon fixation effect,
on the ankle and subtalar joint Biomechanics of impact is not big,
not happen subtalar joint stiffness. Therefore both acute injury or
chronic instability, you can first choose the anatomy of the repair
method, when direct repair difficulties when using non-anatomical
reconstruction method.

(2) non-anatomical reconstruction method. According to the literature
report 50 kinds of surgery and the improvement of operation.
Depending on the reconstruction of the material is different then
divided into three categories: 1, use the fibula muscle. 2, use the
Plantar Aponeurosis, part of the Achilles tendon or autologous
transplantation of free materials. 3, the use of alternative
materials such as carbon fiber, bovine collagen, etc.

Current clinical use most reconstruction material remains the use of
common Peroneal Tendon, surgical operation with Chrisman-Snook: from
proximal tendon of peroneus short cut 1/2 part, first through the
talus neck hole and then through the distal tibia and fibula bones
duct, down through the calcaneal bone duct lateral, finally and
fibula brevis tendon suture. If tendon too short can also be directly
fixed to the outside of the heel bone. This operation uses only half
the fibula brevis tendon, reduce ankle valgus force of impact.
Reconstruction of the tendon after walking in line with the original
ligament Anatomy travel direction, talofibular ligament
reconstruction and redevelopment with ligament ligament, is an ideal
non-anatomical reconstruction method.

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