简单全关节镜下Brostrom技术治疗青少年慢性踝关节外侧不稳定  

Simplified all-arthroscopic Broström technique in treatment of chronic lateral ankle instability in adolescents

作　　者：黄显程 叶素芬 李灿锋 罗勇 李佳峒 邹铭扬 尤田[2] HUANG Xiancheng;YE Sufen;LI Canfeng;LUO Yong;LI Jiatong;ZOU Mingyang;YOU Tian(School of Clinical Medicine,Shandong Second Medical University,Weifang Shangdong,261071,P.R.China;Department of Sports Medicine,Peking University Shenzhen)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261071 [2]北京大学深圳医院运动医学科,广东深圳518036

出　　处：《中国修复重建外科杂志》2025年第4期457-461,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：深圳市卫生经济学会科研基金(202353);深圳市科技计划项目(JCYJ20220530160218040);深圳大学教学改革研究项目(JG2022165);北京大学深圳医院临床研究项目(LCYJ2020005);广东省体育局科技创新和体育文化发展科研项目(GDSS2020N002);广东省自然科学基金(2017A030310616);深圳市三名工程(SZSM202211019);广东省医学科学技术研究基金项目(A2017202、A2024319)。

摘　　要：目的探讨简单全关节镜下Brostrom技术治疗青少年慢性踝关节外侧不稳定的疗效。方法回顾分析2023年6月—2024年5月收治并符合选择标准的21例青少年慢性踝关节外侧不稳定患者临床资料。男18例,女3例;年龄13~18岁,平均16.0岁。左侧9例,右侧12例。均在关节镜下诊断为距腓前韧带(anterior talofibular ligament,ATFL)损伤,其中合并软骨损伤11例、撕脱性骨折5例、踝关节撞击综合征6例。首次扭伤至该次手术时间3~60个月,中位时间12.0个月。简单全关节镜下Brostr?m技术修复ATFL,恢复关节稳定性。手术前后采用疼痛视觉模拟评分(VAS)以及Tegner评分、美国矫形足踝协会(AOFAS)评分、Karlsson踝关节功能评分(KAFS)、足与踝关节评分表(FAOS)评分评价踝关节疼痛及功能,MRI复查韧带愈合情况。结果患者术后均获随访,随访时间8~15个月,平均12.6个月。术后发生切口浅表感染2例、腓浅神经损伤1例、前踝撞击1例、再扭伤1例。末次随访时,踝关节VAS评分、Tenger评分、AOFAS评分、KAFS评分以及FAOS评分均优于术前,差异有统计学意义(P<0.05)。MRI复查示韧带愈合,张力好。结论对于青少年慢性踝关节外侧不稳定,采用简单全关节镜下Brostr?m技术修复ATFL可以有效缓解踝关节疼痛、改善稳定性,获得良好疗效。Objective To investigate effectiveness of simplified all-arthroscopic Broström technique in treatment of chronic lateral ankle instability in adolescents.Methods A clinical data of 21 adolescent patients with chronic lateral ankle instability,who met the selection criteria and were admitted between June 2023 and May 2024,was retrospectively analyzed.There were 18 males and 3 females with an average age of 16.0 years(range,13-18 years).There were 9 cases of left ankle joint injury and 12 cases of right ankle joint injury.Anterior talofibular ligament(ATFL)injury was diagnosed by arthroscopy in all patients.There were 11 cases of cartilage injury,5 cases of avulsion fractures,and 6 cases of ankle impingement syndrome.The time from first sprain to operation ranged from 3-60 months(mean,12.0 months).The ATFL was repaired and the ankle joint stability was restored by simplified all-arthroscopic Broström technique.Visual analogue scale(VAS)score,Tegner score,American Orthopaedic Foot and Ankle Society(AOFAS)score,Karlsson ankle function scale(KAFS)score,Foot and Ankle Outcome Score(FAOS)were used to evaluate ankle pain and function.MRI was used to evaluate the ligament healing.Results All patients were followed up 8-15 months(mean,12.6 months).After operation,1 patient suffered from superficial peroneal nerve injury,1 patient developed anterior scar impingement on the ankle,2 patients had superficial wound infection,and 1 patient suffered from sprain again.The VAS score,Tenger score,AOFAS score,KAFS score,and FAOS score significantly improved when compared with the preoperative scores(P<0.05).MRI examination showed the ligament healing and good tension.Conclusion For adolescent patients with chronic lateral ankle instability,using simplified all-arthroscopic Broström technique to repair ATFL can effectively alleviate ankle pain,improve stability,and achieve good effectiveness.

关 键 词：慢性踝关节外侧不稳定 距腓前韧带 关节镜 韧带修复 青少年 

分 类 号：R687.4[医药卫生—骨科学]