前方双入路全踝关节镜和传统开放手术修复陈旧距腓前韧带损伤的临床疗效分析  

Comparison analysis of the clinical efficacy of anterior double-entry all-ankle arthroscopic repair and traditional open surgery for chronic anterior talofibular ligament injuries

作　　者：戴益科 尹合勇 张京新 马立峰[1] 李智尧 刁乃成[1] Dai Yike;Yin Heyong;Zhang Jingxin;Ma Lifeng;Li Zhiyao;Diao Naicheng(Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《足踝外科电子杂志》2024年第1期24-28,共5页Electronic Journal of Foot and Ankle Surgery

基　　金：国家自然科学基金青年项目(82002285)。

摘　　要：目的本研究旨在评估前方双入路全踝关节镜下距腓前韧带(anterior talofibular ligament,ATFL)修复与传统开放式Broström-Gould修复对陈旧ATFL损伤的治疗效果。方法回顾性分析2021年7月至2022年7月因ATFL损伤收治于首都医科大学附属北京友谊医院的61例患者资料,均为单侧踝关节损伤,均有手术指征,症状持续时间3~36个月。采用前方双入路全踝关节镜下带线锚钉解剖修复ATFL的38例患者纳入关节镜组,采用传统开放式Broström-Gould修复的23例患者纳入开放组。通过随访术后视觉模拟评分法(visual analogue scale,VAS)评分、美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分、踝关节稳定性(前抽屉试验)、并发症(切口愈合、血管神经损伤、韧带再次断裂、感染)情况对手术的临床疗效进行评估。结果61例患者均成功完成手术,并获6~18个月随访。关节镜组平均手术时间为(45.02±4.37)分,显著高于开放手术组的(35.22±5.16)分,差异有统计学意义(P<0.05)。患者手术切口均一期愈合,未发生血管神经损伤、韧带再次断裂、感染等并发症。术后查体患者均获得较好的踝关节稳定性,前抽屉试验均为阴性。末次随访时关节镜组VAS评分为(1.45±0.92)分,显著低于术前的(5.66±1.02)分,差异有统计学意义(P<0.05)。末次随访时关节镜组AOFAS评分为(91.29±3.98)分,显著高于术前的(52.47±7.61)分,差异有统计学意义(P<0.05)。末次随访时开放组VAS评分为(1.78±1.17)分,显著低于术前的(6.04±0.82)分,差异有统计学意义(P<0.05)。末次随访时开放组AOFAS评分为(90.30±4.33)分,显著高于术前的(53.57±6.24)分,差异有统计学意义(P<0.05)。但两组患者末次随访的AOFAS评分和VAS评分差异无统计学意义(P>0.05)。结论前方双入路全踝关节镜下ATFL修复相较于传统开放手术具有创伤小、技术可靠、视野清楚、操作简单等优点,可获得�Objective This study was to evaluate the efficacy of anterior double-approach total ankle arthroscopic repair of the anterior talofibular ligament(ATFL)and traditional open Brostrom-Gould repair in the treatment of aged ATFL injuries.Methods The data of 61 patients admitted to Beijing Friendship Hospital,Capital Medical University,from July 2021 to July 2022 due to ATFL injuries were retrospectively analyzed.All patients had unilateral ankle injuries with surgical indications and symptoms lasting from 3 to 36 months.A total of 38 patients undergoing arthroscopic anatomic repair of ATFL with linear anchor were included in the arthroscopic group and 23 patients undergoing conventional open Brostrom-Gould repair were included in the open group.The visual analogue scale(VAS)score and the American Orthopedic Foot and Ankle Society(AOFAS)ankle-posterior foot score,ankle stability(front drawer test),and complications(wound healing,vaso-nerve injury,ligament re-rupture,infection)were used to evaluate the clinical outcome of the surgery.Results All 61 patients successfully underwent surgery and were followed up for 6 to 18 months.The mean operation time in arthroscopic group was(45.02±4.37)points,significantly higher than(35.22±5.16)points of the open surgery group,with statistical significance(P<0.05).The surgical incisions of the patients all healed primarily,with no occurrences of vascular and nerve injuries,ligament re-rupture,or infection.Postoperative physical examinations showed good ankle joint stability,with negative anterior drawer tests.At the final follow-up,the VAS score in the arthroscopic group was(1.45±0.92)points,significantly lower than the preoperative score of(5.66±1.02)points,with statistical significance(P<0.05).The AOFAS score at the final follow-up was(91.29±3.98)points,significantly higher than the preoperative score of(52.47±7.61)points,with statistical significance(P<0.05).In the open group,the VAS score at the final follow-up was(1.78±1.17)points,significantly lower than the preoperative

关 键 词：踝关节镜 距腓前韧带损伤 踝关节不稳 韧带修复 

分 类 号：R687.4[医药卫生—骨科学]