慢性踝外侧不稳镜下与开放韧带修复比较  

Arthroscopic versus open Brostrom-Gould procedure for chronic lateral ankle instability

作　　者：王传鑫 于永杰[3] 马亮 WANG Chuan-xin;YU Yong-jie;MA Liang(Shandong University of Traditional Chinese Medicine,Jinan 250014,China;The Affiliated Hospital,Shandong University of Traditional Chinese Medicine,Jinan 250011,China;Yidu Central Hospital of Weifang City,Weifang 262500,China)

机构地区：[1]山东中医药大学附属医院,山东济南250014 [2]山东中医药大学,山东济南250011 [3]潍坊市益都中心医院,山东潍坊262500

出　　处：《中国矫形外科杂志》2023年第11期998-1003,共6页Orthopedic Journal of China

基　　金：山东省自然科学基金面上项目(编号:ZR2021MH071);2021年度山东省博士后创新项目(编号:202103083);中国博士后科学基金第68批面上资助二等项目(编号:2020M682220);中国博士后科学基金第14批特别资助项目(编号:2021T140423);泰山学者工程专项经费资助项目(编号:tsqn202211350)。

摘　　要：[目的]比较镜下与开放Brostr?m-Gould术修复距腓前韧带(anterior talofibular ligament,ATFL)治疗慢性踝关节外侧不稳的临床疗效。[方法]回顾性分析2018年8月—2019年9月手术治疗慢性踝外侧不稳60例患者的临床资料。根据医患沟通结果,30例采用关节镜下修复(镜下组),30例采用开放修复(开放组)。比较两组患者围手术期、随访及影像资料。[结果]两组患者均顺利完成手术,无严重并发症。关节镜组切口总长度、术中失血量、术中透视次数、下地行走时间与住院时间均显著优于开放组(P<0.05)。所有患者均获12个月以上的随访,随时间推移,两组术后踝内-外翻ROM及VAS评分均显著减少(P<0.05),而AOFAS评分显著增加(P<0.05)。术后1个月,镜下组踝背伸-跖屈ROM、踝内-外翻ROM及AOFAS评分均显著优于开放组(P<0.05),但术后12个月时差异均已无统计学意义(P>0.05)。术后两组前抽屉试验与内翻试验均显著改善(P>0.05),但相应时间点两组间上述指标的差异均无统计学意义(P>0.05)。影像方面,与术前相比,术后两组应力位片距骨前移距离与距骨内翻角度均显著减少(P<0.05),但相同时间点两组间差异均无统计学意义(P>0.05)。[结论]关节镜下改良辅助入路与开放Brostr?m-Gould均可有效修复慢性踝关节外侧不稳;关节镜下改良辅助入路更为微创,短期关节功能恢复疗效显著。[Objective]To compare the clinical efficacy of arthroscopic versus open Brostrom-Gould procedure for repair of anterior talofibular ligament(ATFL)in the treatment of chronic lateral ankle instability.[Methods]A retrospective study was conducted on 60 pa-tients who received surgical treatment for chronic lateral ankle instability in our hospitals from August 2018 to September 2019.According to the results of doctor-patient communication,30 patients underwent arthroscopic repair(the arthroscopic group),while the other 30 pa-tients received open repair(the open group).The perioperative period,follow-up and imaging data were compared between the two groups.[Results]All patients in both groups were operated on successfully without serious complications.The arthroscopic group proved signifi-cantly superior to the open group in terms of total incision length,intraoperative blood loss,intraoperative fluoroscopy times,postoperative walking time and hospital stay(P<0.05).As time went during follow-up period lasted for more than 12 months,the VAS score and eversion-inversion range of motion(ROM)significantly declined(P<0.05),while the AOFAS score significantly increased in both groups(P<0.05).At 1 month afer operation,the arthroscopic group proved significantly superior to the open group in dorsal extension plantar flexion ROM,eversion-inversion ROM and AOFAS score(P<0.05),whereas which became not statistically significant at 12 months after operation(P>0.05).In addition,the anterior drawer test and varus test were significantly improved postoperatively in both groups(P<0.05),but there was no significant difference between the two groups at any corresponding time points(P>0.05).Regarding imaging,the anterior displacement and talus tilt under stress on X-ray films significantly decreased in both groups after operation(P<0.05),which were not significantly differ-ent between the two groups at any matching time points(P>0.05).[Conclusion]Both arthroscopic and open Brostrom-Gould procedures do effectively repair chronic lateral

关 键 词：踝关节外侧不稳 距腓前韧带 关节镜术 开放手术 

分 类 号：R687[医药卫生—骨科学]