关节镜下改良Brostrom手术治疗距腓前韧带损伤的临床研究  

A clinical study of arthroscopic modified Brostrom procedure for treatment of anterior talofibular ligament injuries

作　　者：丁小方 徐海林[2] 周君琳[3] 王元利 芦浩[2] 袁玉松 吕昊润 纪坤羽 杨黎黎 周海涛 杨坤 DING Xiaofang;XU Hailin;ZHOU Junlin;WANG Yuanli;LU Hao;YUAN Yusong;LYU Haorun;JI Kunyu;YANG Lili;ZHOU Haitao;YANG Kun(Beijing Longfu Hospital,Beijing 100010,China;Peking University People’s Hospital,Beijing 100044,China;Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]北京市隆福医院,北京100010 [2]北京大学人民医院,北京100044 [3]首都医科大学附属北京朝阳医院,北京100020

出　　处：《中医正骨》2022年第10期32-37,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：北京市科技计划项目(Z181100001718159)。

摘　　要：目的:观察关节镜下改良Brostrom手术治疗距腓前韧带损伤的临床疗效和安全性。方法:回顾性分析51例距腓前韧带损伤患者的病例资料,其中采用关节镜下改良Brostrom手术治疗23例(关节镜手术组),采用开放改良Brostrm手术治疗28例(开放手术组)。比较2组患者的手术时间、住院时间、踝关节疼痛视觉模拟量表(visual analog scale,VAS)评分、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及并发症发生率。结果:①一般结果。关节镜手术组手术时间、住院时间均短于开放手术组[(33.8±6.7)min,(42.1±8.5)min,t=1.468,P=0.001;(2.2±1.4)d,(5.8±1.6)d,t=1.975,P=0.002]。②踝关节疼痛VAS评分。时间因素和分组因素存在交互效应(F=0.378,P=0.018);2组患者的踝关节疼痛VAS评分总体比较,组间差异无统计学意义,即不存在分组效应(F=1.865,P=0.163);手术前后不同时间点踝关节疼痛VAS评分的差异有统计学意义,即存在时间效应(F=1.675,P=0.000);2组患者踝关节疼痛VAS评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致[(7.78±1.23)分,(1.23±1.24)分,(1.03±0.35)分,(1.01±0.28)分,F=0.568,P=0.000;(7.45±1.43)分,(1.45±1.87)分,(1.23±0.55)分,(1.04±0.37)分,F=1.358,P=0.000];术前及术后6个月、12个月,2组患者踝关节疼痛VAS评分比较,组间差异无统计学意义(t=2.987,P=0.055;t=1.654,P=2.542;t=0.015,P=0.078);术后3个月,关节镜手术组患者踝关节疼痛VAS评分低于开放手术组(t=1.267,P=0.023)。③AOFAS踝与后足评分。时间因素和分组因素存在交互效应(F=2.693,P=0.027);2组患者的AOFAS踝与后足评分总体比较,组间差异无统计学意义,即不存在分组效应(F=1.983,P=0.106);手术前后不同时间点AOFAS踝与后足评分的差异有统计学意义,即存在时间效应(F=34.623,P=0.000);2组患者AOFAS踝与后足评分随时间变化均呈上升趋势,但2组的上升趋势不完全一致[(48.19±12.89)分,(89.Objective:To observe the clinical efficacy and safety of arthroscopic modified Brostrom procedure for treatment of anterior talofibular ligament(ATFL)injuries.Methods:The clinical data of 51 patients with ATFL injuries were retrospectively analyzed.Twenty-three patients were treated with arthroscopic modified Brostrom procedure(arthroscopic procedure group),and 28 cases with open modified Brostrom procedure(open procedure group).The operative time,hospital stays,ankle pain visual analog scale(VAS)score,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and complication incidence were compared between the 2 groups.Results:①The operative time and hospital stays were shorter in arthroscopic procedure group compared to open procedure group(33.8±6.7 vs 42.1±8.5 minutes,t=1.468,P=0.001;2.2±1.4 vs 5.8±1.6 days,t=1.975,P=0.002).②There was interaction between time factor and group factor in ankle pain VAS score(F=0.378,P=0.018).There was no statistical difference in the ankle pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=1.865,P=0.163).There was statistical difference in the ankle pain VAS scores between different timepoints before and after the procedure,in other words,there was time effect(F=1.675,P=0.000).The ankle pain VAS scores presented a downward trend over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(7.78±1.23,1.23±1.24,1.03±0.35,1.01±0.28,F=0.568,P=0.000;7.45±1.43,1.45±1.87,1.23±0.55,1.04±0.37 points,F=1.358,P=0.000).There was no statistical difference in the ankle pain VAS scores between the 2 groups before the procedure and at 6 and 12 months after the procedure(t=2.987,P=0.055;t=1.654,P=2.542;t=0.015,P=0.078),however,at 3 months afer the procedure,the ankle pain VAS scores were lower in arthroscopic procedure group compared to open procedure group(t=1.267,P=0.023).③There was interaction between time factor and group factor in AOFAS ankle-hindfoot score(F=2.693,P=0.027).Ther

关 键 词：踝损伤 外侧韧带 踝 关节镜检查 改良Brostrom手术 临床试验 

分 类 号：R687.4[医药卫生—骨科学]