慢性踝外侧不稳经皮韧带重建与镜下韧带修复比较△

Comparison of percutaneous ligament reconstruction versus arthroscopic ligament repair for chronic lateral ankle instabili-ty

摘要:

[目的]比较经皮距腓前韧带(anterior talofibular ligament, ATFL)和跟腓韧带(calcaneofibular ligament, CFL)重建与镜下 ATFL 修复治疗慢性踝外侧不稳定的临床疗效。[方法]回顾性分析 2015 年 10 月—2020 年 7 月本院收治的慢性踝不稳 35 例患者的临床资料，依据医患沟通结果，19 例采用经皮重建 (经皮组)，16 例采用镜下修补 (镜下组)。比较两组围手术期、 随访及影像资料。[结果]两组患者均顺利完成手术，术中无神经、血管损伤等严重并发症。经皮组手术时间、切口长度、术中出血量及平均住院天数均显著多于镜下组(P＜0.05)。两组患者均获 24 个月以上随访，经皮组完全负重活动时间显著长于镜下组(P＜ 0.05)。随时间推移，两组 VAS 均显著减少(P＜0.05)，而 AOFAS 和 KAFS 评分显著增加(P＜0.05)，踝背伸-跖屈 ROM 无显著变化 (P＞0.05)。相应时间点，两组患者上述指标的差异均无统计学意义(P＞0.05)。影像方面，与术前相比，术后 12 个月和 24 个月两组内翻应力位距骨倾斜角、前抽屉应力位距骨前移均明显减少(P＜0.05)，Kellgren-Lawrence 踝关节骨性关节炎分期无明显变化(P＞ 0.05)。术前两组之间的距骨倾斜角、距骨前移比较差异无统计学意义(P＞0.05)，术后 12、24 个月，经皮组的距骨倾斜角、距骨前移均显著小于镜下组(P＜0.05)。相应时间点，两组间 Kellgren-Lawrence 踝关节骨性关节炎分期的差异无统计学意义(P＞0.05)。 [结论]镜下组手术创伤小，恢复快，但是经皮韧带重建的稳定性更好，适合于对踝关节功能要求较高的人群。

Abstract:

[Objective] To compare the clinical efficacy of percutaneous anterior talofibular ligament (ATFL) and calcaneofibular liga- ment (CFL) reconstruction versus arthroscopic ATFL repair for chronic lateral ankle instability. [Methods] A retrospective study was done on 35 patients who underwent surgical treatment for chronic lateral ankle instability in our hospital from October 2015 to July 2020. Accord- ing to doctor-patient communication, 19 patients were treated with percutaneous reconstruction of ATFL and CFL (the percutaneous group) , while the remaining 16 patients received arthroscopic repair of ATFL (the arthroscopic group) . The documents regarding to perioperative pe- riod, follow-up and stress radiographs were compared between the two groups. [Results] All the patients in both groups had operation per- formed successfully without serious complications such as neurovascular injury. The percutaneous group proved significantly inferior to the arthroscopic group in terms of operation time, incision length, intraoperative blood loss and hospital stay (P＜0.05) . All patients in both groups were followed up for more than 24 months, and the percutaneous group resumed full weight-bearing activity significantly later than the arthroscopic group (P＜0.05) . The VAS decreased significantly (P＜0.05) , while AOFAS and KAFS scores increased significantly over time in both groups (P＜0.05) , whereas the ankle dorsal extension – plantar flexion range of motion (ROM) remained unchanged (P＞0.05) . At any corresponding time points, there was no significant difference in the above items between the two groups (P＞0.05) . Radiographically, the talus inclination angle under varus stress and talus anterior displacement under anterior drawer stress significantly reduced in both groups at 12 and 24 months after operation compared with those preoperatively (P＜0.05) , while the Kellgren-Lawrence classification for os- teoarthritis remained unchanged (P＞0.05) . Although there was no significant difference in talus inclination and talus anterior displacement between the two groups before operation (P＞0.05) , the percutaneous group proved significantly superior to the arthroscopic group in talus in-clination and talus anterior displacement at 12 and 24 months postoperatively (P＜0.05) . However, there was no significant difference in Kell- gren-Lawrence classification of ankle osteoarthritis between the two groups at any corresponding time points (P＞0.05) . [Conclusion] The arthroscopic repair of ATFL has advantages of less iatrogenic trauma and faster recovery, while the percutaneous reconstruction of ATFL and CFL regains better ankle stability, which is suitable for people with higher requirements of ankle function.