全内关节镜下外侧韧带加强术治疗慢性踝关节外侧旋转不稳定的临床效果分析  

Comparison of the clinical efficacy of all-inside arthroscopic lateral ligament augmentation procedure and Broström procedure for the treatment of chronic lateral rotational ankle instability

作　　者：罗信 薛冲 陈杰 薛越 冯仕明 Luo Xin;Xue Chong;Chen Jie;Xue Yue;Feng Shiming(Department of Sport Medicine,the Xuzhou Clinical College of Xuzhou Medical University,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州医科大学徐州临床学院,徐州市中心医院运动医学科,徐州221009

出　　处：《中华外科杂志》2024年第6期581-590,共10页Chinese Journal of Surgery

基　　金：江苏省卫健委科研项目(H2023023);徐州市医学重点人才项目(XWRCHT20220047)。

摘　　要：目的比较全内关节镜下Broström-Gould术和Broström术治疗慢性踝关节外侧旋转不稳定(CLRAI)的临床效果。方法本研究为回顾性队列研究。回顾性分析2021年1月至2022年12月徐州市中心医院骨科收治的106例CLRAI患者的临床及影像学资料。男性55例,女性51例,年龄(32.6±8.2)岁(范围:16~50岁)。患者均采用全内关节镜下治疗,按照韧带修复方式不同,分为Broström-Gould术组(54例)和Broström术组(52例)。术后3、6、12个月采用踝关节内翻应力试验和踝关节前抽屉试验检查踝关节稳定情况,并观察患者步态。采用美国足踝外科协会踝与后足评分(AOFAS-AH)和Karlsson踝关节功能评分(KAFS)评价踝关节功能;采用Tegner评分评估患者运动水平;采用足与踝关节预后评分(FAOS)(包含症状、疼痛、日常活动、运动、生活质量5项评分)评估患者日常活动能力。数据比较采用独立样本t检验、重复测量方差分析、LSD-t多重比较、χ^(2)检验或Mann-Whitney U检验。结果两组患者均顺利完成手术,切口均一期愈合,未出现感染,神经、血管损伤等并发症。术后3、6、12个月所有患者获得随访,踝关节内翻应力试验和踝关节前抽屉试验检查结果均为阴性,患者均恢复正常步态,无踝关节机械性不稳定及功能性不稳定,无患者接受翻修手术。重复测量方差分析结果显示,Broström-Gould术组和Broström术组患者术后AOFAS-AH、Tegner、KAFS、FAOS评分均较术前明显提高(P值均<0.01)。两组患者Tegner评分和FAOS中的运动评分,组间变化趋势的差异有统计学意义(F=18.839,P<0.01;F=8.169,P=0.005)。LSD-t多重比较发现术后3、6、12个月随访时,Broström-Gould组的Tegner评分[3个月:(3.7±0.5)分比(3.3±0.5)分,LSD-t=-3.980,P<0.01;6个月:(4.4±0.6)分比(3.8±0.7)分,LSD-t=-4.792,P<0.01;12个月:(5.8±0.9)分比(5.1±1.0)分,LSD-t=-3.889,P<0.01]和FAOS中的运动评分[3个月:(82.5±3.7)分比(79.3±3.8)分,LSD-t=-4.316,PObjective To compare the clinical efficacy of patients with chronic lateral rotational ankle instability(CLRAI)after all-inside arthroscopic lateral ligament augmentation procedure and Broström procedure.Methods This is a retrospective cohort study.The clinical and imaging data of 106 CLRAI patients were collected at the Xuzhou Central Hospital from January 2021 to December 2022.The patients included 55 males and 51 females with an age of(32.6±8.2)years(range:16 to 50 years).All patients were treated under all-inside arthroscopic,and were divided into Broström-Gould surgery group(n=54)and Broström surgery group(n=52)according to different ligament repair methods.At 3,6,and 12 months after surgery,ankle inversion stress tests and anterior drawer tests were used to examine the stability of the ankle joint and observe gait.The American Orthopedic Foot and Ankle Society ankle hindfoot scale(AOFAS-AH)and Karlsson ankle function score(KAFS)were used to assess ankle function;Tegner score was used to assess the patient′s level of exercise;the foot and ankle outcome score(FAOS)including score of symptoms,pain,function,daily living,function,sports and recreational activities(sport);quality of life(QOL)was used to assess the patient′s daily activity ability.Comparisons of data were made using independent sample t test,repeated measures analysis of variance,LSD-t multiple comparison method,χ^(2) test or Mann-Whitney U test.Results All operations were successfully accomplished.All incisions healed by first intention,without evidence of postoperative complications of implant rejection,ligation reaction,and nerve and vessel injury.All patients were followed up at 3,6,and 12 months after surgery.Ankle varus stress test and anterior drawer test were negative.No evidence supporting lateral ankle instability was obtained.All patients eventually regained normal gait.No patients underwent revision surgery.Repeated measurement analysis of variance showed that AOFAS-AH,Tegner,KAFS and FAOS scores in the Brostrom-Gould group an

关 键 词：踝关节 关节不稳定性 踝关节外侧旋转不稳定 外侧韧带 关节镜 Broström-Gould术 Broström术 

分 类 号：R687.4[医药卫生—骨科学]