改良辅助入路全关节镜下修复踝关节外侧副韧带  

Lateral Ankle Ligament Repair by Using Modified Accessory Approach Total Arthroscopic Technique

作　　者：江东[1] 胡跃林[1] 焦晨[1] 郭秦炜[1] 谢兴[1] 陈临新[1] 赵峰[1] 皮彦斌[1] Jiang Dong;Hu Yuelin;Jiao Chen(Institute of Sports Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院运动医学研究所,北京100191

出　　处：《中国微创外科杂志》2019年第1期11-14,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：国家自然科学基金(31670982;81672153);北京大学临床医学+X青年项目(PKU2018LCXQ009);北京大学第三医院临床重点项目(BYSY2017022)

摘　　要：目的探讨改良辅助入路全关节镜下修复踝关节外侧副韧带的近期效果。方法 2018年4～7月,对24例慢性踝关节不稳行踝关节镜检查、改良辅助入路全关节镜下外侧副韧带修复术。术前踝关节前抽屉试验阳性,MRI确诊踝关节外侧副韧带陈旧损伤。术中除常规前内、前外入路,增加一个距腓前韧带上方辅助入路用于关节镜下距腓前韧带和伸肌下支持带缝合。结果中位随访时间5(4～6)个月。与术前水平相比,末次随访疼痛视觉模拟评分(Visual Analogue Scale,VAS)[中位数3(0～6) vs. 1 (0～6),Z=-3. 282,P=0. 001]、美国足踝骨科协会(American Orthopaedic Foot and Ankle Society,AOFAS)足踝评分(77±11 vs. 93±6,t=-6. 288,P=0. 000)及Tegner评分(3. 5±2. 1 vs. 4. 2±1. 9,t=-2. 186,P=0. 039)均明显改善。术后22例(91. 7%)踝关节前抽屉试验阴性,未见切口及神经并发症。2例踝关节跖屈受限(0°～5°),1例背伸受限(0°～5°)。术后3个月24例中22例(91. 7%)恢复日常生活; 9例术后随访6个月,其中7例恢复至伤前运动水平。结论改良辅助入路全关节镜下外踝韧带修复技术操作简便,重复性好,短期临床效果良好,康复时间短。Objective To investigate the short-term outcome of the lateral ankle ligament repair by using modified total arthroscopic technique with an accessory approach. Methods The study was performed with 24 patients with chronic lateral instability undergoing anatomic lateral ankle ligament repair by using modified arthroscopic technique from April 2018 to July 2018.All the patients were confirmed positive anterior drawer test and chronic lateral ankle ligament injury at MRI.In addition to the conventional anterior medial and the anterior lateral portals,an assisted portal above anterior talofibular ligament was added to do the arthroscopic ligament and extensor retinaculum repair. Results The median follow-up was 5 months (range,4-6 months).As compared with the preoperative level,the last postoperative Visual Analogue Scale (VAS) score [3 (0-6) vs.1 (0-6),Z=-3.282,P=0.001],American Orthopaedic Foot and Ankle Society (AOFAS) score (77±11 vs.93±6,t=-6.288,P=0.000) and Tegner score (3.5±2.1 vs.4.2±1.9,t=-2.186,P=0.039) were all improved with significant difference.Postoperative anterior drawer tests were negative in 22 cases (91.7%).No incision or neurological complications were observed.The ankle joint flexion was mildly restricted (0°-5°) in 3 patients.At postoperative 3 months,22 of 24 patients (91.7%) recovered their daily lives.At postoperative 6 months,7 of 9 patients returned to pre-injury exercise. Conclusion The modified accessory approach for total arthroscopic lateral ankle ligament repair is simple,reproducible,and short-term clinically effective,and shortens the recovery time of the lateral ankle ligament repair.

关 键 词：慢性踝关节不稳 踝关节 韧带损伤 关节镜 改良入路 

分 类 号：R687.4[医药卫生—骨科学]