不同方法修复踝关节外侧副韧带慢性损伤的稳定性评价  

Repairing ankle lateral collateral ligament chronic injury using different methods: A stability assessment

作　　者：焦晨[1] 胡跃林[1] 郭秦炜[1] 王成[1] 梅宇[1] 谢兴[1] 杨渝平[1] 陈临新[1] 江东[1] 

机构地区：[1]北京大学第三医院运动医学研究所,北京市100191

出　　处：《中国组织工程研究》2013年第13期2358-2367,共10页Chinese Journal of Tissue Engineering Research

摘　　要：背景:以往有多种修复和重建方式来恢复踝关节外侧稳定性,但这些术式均存在一些缺陷。目的:比较改良Karlsson法与改良Brostrm法修复慢性踝关节外侧不稳的力学变化。方法:73例慢性踝关节外侧不稳患者,其中43例患者接受了改良Brostrm手术,30例患者接受了改良Karlsson手术,平均随访(50.8±26.5)个月和(49.5±11.1)个月,记录软骨损伤的情况,治疗前和治疗后随访进行AOFAS评分、Mazur评分、Tegner评分、客观检查(前抽屉试验和内翻应力试验)、满意度评分和调查再伤情况。结果与结论:所有患者中38.4%合并软骨损伤,40.5%发生在距胫关节前内侧关节面(距骨Ⅰ区和胫骨Ⅰ区)。随访时两组患者Mazur评分、Tegner评分均明显高于术前,组间无显著性差异。AOFAS评分治疗后较治疗前提高的分值改良Karlsson组明显高于改良Brostrm组。除改良Brostrm组有1例治疗后阳性外,两组其他患者抽屉试验和内翻应力试验治疗后均为阴性。改良Karlsson组治疗时间明显短于改良Brostrm组,满意度评分两组差异无显著性意义。改良Brostrm组2例再伤,改良Karlsson组1例再伤。结果表明,改良Karlsson治疗具有与改良Brostrm治疗效果相似、操作更便捷。BACKGROUND： There are many repair and reconstruction methods to restore the stability of lateral ankle joint.OBJECTIVE： To compare the mechanical changes of modified Karlsson procedure and modified Brostrām procedure for the treatment of lateral chronic ankle instability.METHODS： Seventy-three patients with lateral chronic ankle instability were enrolled, among whom, 43 consecutive patients were treated with modified Brostrām procedure and followed-up for average （50.8±26.5） months, and 30 consecutive patients underwent modified Karlsson procedure and followed-up for （49.5±11.1） months. Chondral lesions, American Orthopaedic Foot and Ankle Society score, Mazur score, Tegner score, satisfaction score and re-injury situation were recorded before and after treatment. Objective examinations including drawer test and inversion stress test were also done for assessment.RESULTS AND CONCLUSION： 38.4% patients had chondral lesions, and 40.5% lesions occurred in the anteromedial facet of the talocrural joint （talus zone I and tibia region I）. Mazur score and Tegner score were significantly improved postoperatively in modified Brostrā m group and modified Karlsson group. There were no significant differences on Mazur score and Tegner score between two groups. The improved American Orthopaedic Foot and Ankle Society score in the modified Karlsson group was significantly higher than that in the modified Brostr？m group. The drawer test and inversion stress test were negative in two groups, except positive in one patient in modified Brostrām group. The treatment time in the modified Karlsson group was significantly shorter than that in the modified Brostrām group, and there was no significant difference in satisfaction score between two groups. There were two cases of re-injury in modified Brostrām group while one case in modified Karlsson group. Modified Karlsson procedure has the treatment effect similar to modified Brostr？m procedure, but it is easier to operate.

关 键 词：骨关节植入物 骨与关节生物力学 踝关节 踝 外侧 稳定性 距骨 胫骨 Mazur评分 Tegner 评分 抽屉试验 内翻应力试验 

分 类 号：R318[医药卫生—生物医学工程]