慢性踝外侧不稳镜下与开放距腓前韧带重建比较△

Arthroscopic reconstruction of anterior talofibular ligament versus open counterpart for chronic lateral ankle instability

摘要:

[目的] 比较关节镜下距腓前韧带 (anterior talofibular ligament, ATFL) 重建与传统开放重建治疗慢性踝关节外侧不稳(chronic lateral ankle instability, CLAI)的初步临床效果。[方法]回顾性分析 2015 年 2 月—2020 年 3 月本院骨科收治的踝关节外侧不稳 46 例患者的临床资料。其中，24 例采用关节镜 ATFL 重建，22 例采用常规开放 ATFL 重建。比较两组围手术期、 随访和影像学资料。[结果]两组患者均顺利完成手术，均未发生严重并发症。关节镜组总切口长度、术中出血量及住院时间等均显著优于开放组(P＜0.05)，两组手术时间和切口愈合等级的差异无统计学意义(P＞0.05)。关节镜组下地行走时间和完全负重活动时间均显著早于开放组(P＜0.05)。与术前相比，末次随访时两组患者前抽屉试验和内翻试验均显著改善(P＜0.05)，AOFAS 评分均显著增加(P＜0.05)，ROM 无改变(P＞0.05)，而 VAS 评分显著减少(P＜0.05)；末次随访时，关节镜组除 ROM 外的其余上述指标均显著优于显著优于开放组(P＜0.05)。影像方面，末次随访时两组距骨前移距度和距骨倾斜角均较术前显著减少(P＜ 0.05)，相应时间点，两组间上述影像指标的差异均无统计学意义(P＞0.05)。[结论] 对于踝关节外侧不稳，关节镜下 ATFL 重建治疗可取得更好的临床效果。

Abstract:

[Objective] To compare the preliminary clinical outcomes of arthroscopic reconstruction of anterior talofibular ligament (ATFL) versus the traditional open reconstruction for chronic lateral ankle instability (CLAI) . [Methods] A retrospective study was done on a total of 46 patients who underwent ATFL reconstruction for chronic lateral ankle instability in our hospital from February 2015 to March 2020. Among them, 24 patients underwent arthroscopic ATFL reconstruction, while the other 22 patients underwent conventional open AT- FL reconstruction. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups were successfully operated on without serious complications. The arthroscopic group proved significantly superior to the open group in terms of total incision length, intraoperative blood loss and hospital stay (P＜0.05) , despite of the fact that no significant differences were noted in operation time and incision healing between them (P＞0.05) . The arthroscopic group resumed walking and full weight-bearing ac- tivity significantly earlier than the open group (P＜0.05) . Compared with those preoperatively, the anterior drawer test and varus test signifi- cantly improved (P＜0.05) , AOFAS scores significantly increased (P＜0.05) , the ankle dorsal extension- planter flexion range of motion (ROM) remained unchanged (P＞0.05) , and VAS score significantly decreased (P＜0.05) at the latest follow up in both groups. The ar- throscopic group was significantly better than the open group in the abovementioned indicators at the last interview (P＜0.05) . Radiographi- cally, talus anterior displacement and talus lateral inclination measured on stress X-ray films were significantly reduced in both groups at the last follow-up compared with those preoperatively (P＜0.05) , which was not significantly different between the two groups at any corre- sponding time points (P＞0.05) . [Conclusion] The arthroscopic ATFL reconstruction achieves better clinical outcome over the conventional open reconstruction for chronic lateral ankle instability.