改良Broström术治疗慢性踝关节外侧不稳定中是否需要切除腓骨小体  

Is subfibular ossicle excision necessary in the modified Broström procedure for chronic lateral ankle instability?

作　　者：黄若昆 黄雯洁 雷波 刘丰 肖凯 潘昊[1] 谢鸣 王俊文[1] Huang Ruokun;Huang Wenjie;Lei Bo;Liu Feng;Xiao Kai;Pan Hao;Xie Ming;Wang Junwen(Department of Foot&Ankle Surgery,Wuhan Fourth Hospital,Puai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430033,China)

机构地区：[1]武汉市第四医院,华中科技大学同济医学院附属普爱医院足踝外科,武汉430033

出　　处：《中华创伤骨科杂志》2022年第7期624-628,共5页Chinese Journal of Orthopaedic Trauma

基　　金：武汉市医学科研面上项目(WX21B19)。

摘　　要：目的探讨改良Broström术治疗慢性踝关节外侧不稳定(CLAI)中切除腓骨小体与否对手术疗效的影响。方法回顾性分析2014年3月至2018年12月华中科技大学同济医学院附属普爱医院足踝外科手术治疗的76例CLAI患者资料。根据患者有无腓骨小体分为腓骨小体组(33例)和无腓骨小体组(43例)。腓骨小体组,男19例,女14例;年龄(28.4±8.6)岁。无腓骨小体组,男21例,女22例;年龄(27.8±7.4)岁。腓骨小体组切除腓骨小体。所有患者均采用锚钉缝合改良Broström手术治疗CLAI。比较两组患者术前和末次随访时的美国足踝外科协会(AOFAS)的踝-后足评分和视觉模拟评分(VAS)。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后随访24~72个月(平均28个月)。末次随访时腓骨小体组AOFAS的踝-后足评分由术前(54.5±3.4)分提高至(95.7±2.1)分,非腓骨小体组AOFAS的踝-后足评分由术前(56.2±2.7)分提高至(95.2±2.4)分;腓骨小体组VAS评分由术前(5.7±1.8)分降至(1.6±1.4)分,非腓骨小体组VAS评分由术前(5.7±1.6)分降至(1.7±1.2)分。两组患者末次随访时AOFAS的踝-后足评分、VAS评分比较差异均无统计学意义(P>0.05)。结论在治疗有腓骨小体的CLAI患者中,改良Broström术联合腓骨小体切除术与无腓骨小体患者的韧带修复术相比,具有相似的疗效,建议在有腓骨小体的CLAI患者中切除腓骨小体。Objective To investigate the effect of subfibular ossicle excision on the clinical efficacy of Broström procedure for chronic lateral ankle instability(CLAI).Methods From March 2014 to December 2018,76 patients were treated by the modified Broström procedure using the suture anchor technique for CLAI at Department of Foot&Ankle Surgery,Wuhan Fourth Hospital.Of them,33 had subfibular ossicles(SFO group)and 43 did not(NSFO group).In the SFO group,there were 19 males and 14 females,aged(28.4±8.6)years;in the NSFO group,there were 21 males and 22 females,aged(27.8±7.4)years.Subfibular ossicles were excised in the SFO group.The 2 groups were compared in terms of American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores and visual analogue scale(VAS)pain scores at preoperation and the final follow-up.Results The 2 groups were comparable due to insignificant differences between them in their preoperative general data(P>0.05).All the patients were followed up for 24 to 72 months(average,28 months).The AOFAS ankle-hindfoot scores improved significantly from 54.5±3.4 to 95.7±2.1 in the SFO group and significantly from 56.2±2.7 to 95.2±2.4 in the NSFO group at the final follow-up;the VAS scores reduced significantly from 5.7±1.8 to 1.6±1.4 in the SFO group and significantly from 5.7±1.6 to 1.7±1.2 in the NSFO group at the final follow-up(all P<0.05).No significant differences were found between the 2 groups in terms of AOFAS or VAS scores at the final follow-up(P>0.05).Conclusion Since the modified Broström procedure plus subfibular ossicle excision may result in similar good clinical efficacy as merely the modified Broström procedure may for the CLAI patients without subfibular ossicle,subfibular ossicle excision should be suggested for the CLAI patients with subfibular ossicle.

关 键 词：外侧韧带 踝 关节不稳定性 扭伤和劳损 改良Broström术 腓骨小体 

分 类 号：R687.4[医药卫生—骨科学]