Internal Brace加强对全关节镜下Brostrom⁃Gould修复术治疗慢性踝关节外侧不稳定短期疗效的影响  

Impact of Internal Brace augmentation on the short-term efficacy of all inside endoscopic Brostrom-Gould repair in the treatment of chronic lateral ankle instability

作　　者：熊李 张弓皓 柴斌 匡垓下[1] 季云瀚 XIONG Li;ZHANG Gonghao;CHAI Bin;KUANG Gaixia;JI Yunhan(Department of Orthopaedics,Tong Ren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200050,China)

机构地区：[1]上海交通大学医学院附属同仁医院骨科,上海200050

出　　处：《中华骨与关节外科杂志》2024年第4期314-320,共7页Chinese Journal of Bone and Joint Surgery

基　　金：上海市卫生健康委员会卫生行业临床研究专项青年项目(20224Y0092);2020年度长宁区卫生健康系统“优质+均衡”科研人才发展基金(CNYZ05)。

摘　　要：目的:比较全关节镜下Broström⁃Gould修复联合Internal Brace加强与单纯Broström⁃Gould修复治疗慢性踝关节外侧不稳定(CLAI)的短期疗效。方法:回顾性分析2020年1月至2021年10月接受手术修复的62例踝外侧韧带损伤导致的CLAI患者的临床资料。其中28例患者应用全关节镜下单纯Broström⁃Gould修复治疗(EBG组),34例患者应用全关节镜下Broström⁃Gould修复联合Internal Brace加强治疗(IBG组)。记录两组患者术前与末次随访时疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)踝-后足评分,同时观察并发症发生情况及恢复情况。结果:EBG组患者随访13.0(9,17.3)个月(6~18个月);IBG组患者平均随访(12.3±4.1)个月(6~17个月)。末次随访时EBG组、IBG组患者VAS评分均低于术前[(2.0±0.6)分vs.(6.6±1.2)分,(1.7±0.5)分vs.(6.3±1.1)分],AOFAS评分均高于术前[(89.4±8.1)分vs.(52.0±9.4)分,(91.2±5.1)分vs.(50.1±7.9)分],且差异均有统计学意义(P均<0.001),而两组患者比较差异均无统计学意义(P均>0.05)。EBG组和IBG组分别有23例和31例患者运动水平恢复到损伤前;IBG组患者恢复受伤前活动水平早于EBG组患者[(12.6±2.6)周vs.(20.1±4.1)周],且差异有统计学意义(P<0.001)。EBG组和IBG组分别有3例和1例患者术后仍有持续疼痛和踝关节不稳定症状;EBG组和IBG组各有3例和2例患者出现腓浅神经损伤症状。结论:与全关节镜下单纯Broström⁃Gould修复相比,全关节镜下Broström⁃Gould修复联合Internal Brace加强治疗CLAI在术后早期康复和恢复到损伤前活动水平方面更有优势,同时在术后踝关节功能恢复及疼痛减轻方面也更佳。Objective:To investigate the short-term outcomes of all inside endoscopic Brostrom-Gould repair alone versus combined with Internal Brace augmentation in the treatment of chronic lateral ankle instability.Methods:A retrospective analysis was conducted on 62 patients with chronic lateral ankle instability caused by lateral ligament injury who underwent surgery between January 2020 and October 2021.Among them,28 patients underwent all inside endoscopic Brostrom-Gould repair alone(EBG group),while 34 patients underwent arthroscopic Brostrom-Gould repair combined with Internal Brace augmentation(IBG group).Pain visual analog scale(VAS)scores and American Orthopedic Foot&Ankle Society(AOFAS)ankle-hindfoot scores were recorded for both groups preoperatively and at the final follow-up.The complications and return to preinjury activity levels were also observed.Results:The patients in the EBG group were followed up for 6 to 18 months,with a mean of(13.6±4.3)months,while those in the IBG group were followed up for 6 to 17 months,with a mean of(12.3±4.1)months.At the final follow-up,both the EBG and IBG groups had decreased pain VAS scores[(2.0±0.6)vs.(6.6±1.2),(1.7±0.5)vs.(6.3±1.1)]and increased AOFAS scores[(89.4±8.1)vs.(52.0±9.4),(91.2±5.1)vs.(50.1±7.9)],although these differences were statistically significant(all P<0.001).Moreover,there were no statistically significant differences between the two groups(P>0.05).In the EBG and IBG groups,25 and 33 patients,respectively,regained their preinjury activity level.Patients in the IBG group recovered to their preinjury activity level earlier than those in the EBG group[(12.6±2.6)weeks vs.(20.1±4.1)weeks],with the difference statistically significant(P<0.001).Three patients in the EBG group and one patient in the IBG group still experienced persistent pain and ankle instability symptoms postoperatively.Additionally,three patients in the EBG group and two patients in the IBG group experienced symptoms of superficial peroneal nerve injury postoperatively.Conclusions

关 键 词：慢性踝关节不稳定 关节镜 Internal Brace加强 Broström⁃Gould修复术 短期疗效 

分 类 号：R684.7[医药卫生—骨科学]