关节镜下改良Brostr?m-Gould术式治疗青少年踝关节外侧副韧带损伤锚钉安全性和有效性  

Safety and Effectiveness of Anchor Placement in Arthroscopic Modified Brostr?m-Gould Procedure

作　　者：陈明亮 谷成毅 丁松 周游 Chen Mingliang;Gu Chengyi;Ding Song;Zhou You(Department of Orthopedics,Renhe Hospital Affiliated to Three Gorges University,Yichang 443001,China)

机构地区：[1]三峡大学附属仁和医院骨科,湖北宜昌443001

出　　处：《中国运动医学杂志》2021年第8期601-606,共6页Chinese Journal of Sports Medicine

基　　金：湖北省教育厅科学研究计划重点项目(D20191205);三峡大学科研启动基金(KJ2015A027);宜昌市科技创新项目(A18-301-20)。

摘　　要：目的:探讨关节镜下改良Brostrom-Gould术式治疗青少年踝关节外侧副韧带损伤锚钉安全性和有效性。方法:回顾性分析我院2017年1月至2018年1月接受关节镜下改良Brostr?m-Gould术式治疗的10例(9~15岁)青少年复发性踝关节外侧副韧带损伤患者(实验组)。使用美国足踝外科协会(AOFAS)评分于术前,术后6周、6月、12月及末次随访时对患者进行疗效评价。使用疼痛视觉模拟评分(VAS)于术前,术后1周、1月、6月及末次随访时对患者进行疼痛评分。同时从我院筛选出50例(10~15岁)踝关节正常的青少年(对照组)正侧位X线片。使用影像归档与通信系统(PACS)工具测量两组患者角度α(模拟钻头与踝关节水平所形成的夹角)、距离β(腓骨尖至骨骺线的垂直距离)和距离γ(腓骨上1cm水平腓骨的宽度),并进行统计学分析。结果:实验组所有患者均获得临床一期愈合,未出现相关临床并发症,术后AOFAS评分及VAS评分较术前均有明显改善,差异具有统计学意义。实验组角度α为27.96°、距离β为23.49 mm、距离γ为20.04 mm,对照组角度α为27.15°、距离β为22.63 mm、距离γ为19.69 mm,实验组与对照组α、β、γ值差异均无统计学意义(均P>0.05)。结论:采用关节镜下改良Brostrom-Gould术式修复骨骺未闭的青少年患者外侧副韧带损伤时,术前进行影像学测量及使用改良的体表标志绘制方案,术中对腓骨远端钻孔时准确定位,置钉角度控制在0°~27°内可以有效避免损伤骨骺。ObjectiveTo investigate the safety and effectiveness of arthroscopic modified Brostrom-Gould procedure in the treatment of lateral ankle ligament of adolescents.MethodsTotally 10 adoles-cent patients(9~15 years,experimental group)with recurrent lateral ankle ligament injury and treatedusing the modified Brostr?m-Gould procedure between January 2017 and January 2018 were selected,and evaluated using the American Orthopaedic Foot Ankle Association(AOFAS)score and Visual Ana-logue Scale one week,one month,six months and one year after the operation,as well as during thelast follow-up.Meanwhile,50 adolescents with normal ankle joint radiography(10~15 years,controlgroup)were selected from our hospital.Then,the picture archiving and communication system was em-ployed to measure the simulated angle between the drill and the ankle joint leve(langleα),vertical dis-tance between the tip of fibula and the epiphyseal line(distanceβ)and width of fibula 1 cm above(distanceγ)of both groups.ResultsClinical healing was achieved in all patients in the experimentalgroup without any complications.The average postoperative AOFAS score and VAS score of the experi-mental group improved significantly compared with those before the operation.The average angleα,distanceβand distanceγof the experimental group was 27.96°,23.49 mm,and 20.04 mm respec-tively,showing no significant differences from 27.15°,22.63 mm and 19.69 mm of the control group(P>0.05).ConclusionsDuring the repair of lateral collateral ligament injury of adolescent patientswith patent epiphysis using the arthroscopic modified Brostrom-Gould procedure,the injury of epiphy-seal can be avoided by preoperative imaging measurement and improved body marker drawing,as wellas accurate positioning of distal fibula and controlling the anchoranglewithin 0°to 27°.

关 键 词：青少年 骨骺 踝外侧副韧带 改良Brostr?m-Gould术式 锚钉系统 

分 类 号：R687.4[医药卫生—骨科学]