踝关节镜下增强修复技术与重建技术在慢性踝关节不稳治疗中的疗效比较  

Comparison of clinical efficacy between ankle arthroscopic enhanced repaiRand reconstruction technique in the treatment of chronic ankle instability

作　　者：李宝 张文婷 张振[4] 张桐赫 李灏坤 刘珊珊 刘欣伟 Li Bao;Zhang Wenting;Zhang Zhen;Zhang Tonghe;Li Haokun;Liu Shanshan;Liu Xinwei(.Department of Orthopedics,General Hospital of Northern TheateRCommand,Shenyang 110016,China;Graduate School of China Medical University,Shenyang 110122,China;Department of Special Diagnosis,Dalian Rehabilitation Center,Dalian,Liaoning Province 116000,China;Department of Orthopedics,Huludao Central Hospital,Huludao,Liaoning Province 125000,China)

机构地区：[1]北部战区总医院骨科,沈阳110016 [2]中国医科大学研究生院,沈阳110122 [3]大连康复疗养中心特诊科,辽宁大连116000 [4]葫芦岛市中心医院骨科,辽宁葫芦岛125000

出　　处：《创伤外科杂志》2024年第8期566-573,共8页Journal of Traumatic Surgery

基　　金：辽宁省科学技术计划项目(2022-YGJC-07)。

摘　　要：目的比较全镜下增强修复技术与重建技术治疗慢性踝关节不稳的临床疗效。方法回顾性分析2020年4月—2022年7月北部战区总医院骨科收治的因训练致慢性踝关节不稳患者39例(致伤原因:武装跑步训练13例,战术训练9例,蛇形跑11例,其他体能训练6例),按照手术技术不同分为增强修复组(19例)和重建组(20例)。增强修复组采用3枚带线锚钉对韧带进行增强修复,男性18例,女性1例;年龄21~39岁,平均29.4岁;左侧11例,右侧8例。重建组采用先进韧带增强装置(LARS)重建踝外侧副韧带,男性19例,女性1例;年龄25~42岁,平均26.5岁;左侧9例,右侧11例。分别于术前和术后12个月比较踝关节VAS、美国足踝外科协会(AOFAS)踝及后足评分、肢体对称指数(LSI)、距骨前移距离、距骨倾斜角、术后6个月和12个月重返生活/运动人数比例及术后并发症。结果两组患者术后均随访12~15个月,平均14.7个月。组内术后12个月观察指标均较术前改善[增强修复组:VAS(0.7±0.4)分 vs.(3.8±0.6)分、AOFAS踝及后足评分(92.6±2.5)分vs.(53.6±4.5)分、LSI(84.3%±3.6% vs.70.4%±6.1%)、距骨前移距离(3.1±1.0)mm vs.(9.8±1.6)mm、距骨倾斜角(3.3±1.0)°vs.(9.5±1.1)°;重建组:VAS(0.8±0.5)分vs.(4.0±0.5)分、AOFAS(85.8±4.1)分 vs.(51.2±4.1)分、LSI(77.7%±5.3% vs.69.0%±6.0%)、距骨前移距离(3.1±0.8)mm vs.(10.2±2.2)mm、距骨倾斜角(3.5±0.8)°vs.(9.7±1.5)°],差异有统计学意义(P<0.05);增强修复组术后12个月AOFAS踝及后足评分总分(92.6±2.5)分、LSI(84.3%±3.6%)优于重建组[(85.8±4.1)分,77.7%±5.3%],差异有统计学意义(P<0.05);增强修复组术后6个月重返运动人数比例高于重建组(36.8%vs.5.0%,P<0.05);两组VAS、距骨前移距离、距骨倾斜角、术后12个月重返生活/运动人数比例及术后手术技术相关不良反应(感染、脱钉、血栓)比较差异无统计学意义(P>0.05)。结论两种手术技术用于治疗慢性踝关节不稳的关�Objective To compare the clinical efficacy of total endoscopic enhanced repaiRtechnique and reconstruction technique in the treatment of chronic ankle instability(CAI).Methods A retrospective analysis was conducted on 39 CAI patients at the General Hospital of Northern TheateRCommand from Apr.2020 to Jul.2022.All the CAI were caused by military training,with 13 due to armed running,9 to tactical training,11 to S-shaped running and 6 to physical training.According to different surgical techniques,patients were divided into enhanced repaiRgroup(19 cases,11 affecting the left side and 8 the right)and reconstruction group(20 cases,9 affecting the left side and 11 the right).FoRthe enhanced repaiRgroup,3 suture anchors were used to enhance the repaiRof the ligaments,with 18 males and 1 female aged 21-39(mean 29.4)years.FoRthe reconstruction group,ligament advanced reinforcement system was adopted to reconstruct the lateral collateral ligament of the ankle,with 19 males and 1 female aged 25-42(mean 26.5)years.VAS,American Orthopaedic Foot and Ankle Society(AOFAS)scores,limb symmetry index(LSI),anterioRdisplacement distance and inclination angle of the talus were compared before and 12 months afteRsurgery,as well as the proportions of patients returning to life/exercise at 6 and 12 months afteRsurgery,and postoperative complications.Results Both groups were followed foR12-15(mean 14.7)months.At postoperative 12 months,all patients were significantly improved in pain,functional recovery and anatomic reduction:enhanced repaiRgroup VAS 0.7±0.4 vs.3.8±0.6,AOFAS total score 92.6±2.5 vs.53.6±4.5,LSI 84.3%±3.6%vs.70.4%±6.1%,talus anterioRdisplacement distance(3.1±1.0)mm vs.(9.8±1.6)mm and talus inclination angle 3.3°±1.0°vs.9.5°±1.1°;reconstruction group:VAS 0.8±0.5 vs.4.0±0.5,AOFAS total score 85.8±4.1 vs.51.2±4.1,LSI 77.7%±5.3%vs.69.0%±6.0%,talus anterioRdisplacement distance(3.1±0.8)mm vs.(10.2±2.2)mm and talus inclination angle 3.5°±0.8°vs.9.7°±1.5°(all P<0.05 compared with that before surgery).

关 键 词：慢性踝关节不稳 踝关节 关节镜 距腓前韧带 重建手术 

分 类 号：R684.7[医药卫生—骨科学]