慢性踝外侧不稳镜下与开放韧带修复比较△

Arthroscopic versus open Broström-Gould procedure for chronic lateral ankle instability

摘要:

[目的] 比较镜下与开放 Brostr?m-Gould 术修复距腓前韧带 （anterior talofibular ligament, ATFL） 治疗慢性踝关节外侧不稳的临床疗效。[方法]回顾性分析 2018 年 8 月—2019 年 9 月手术治疗慢性踝外侧不稳 60 例患者的临床资料。根据医患沟通结果，30 例采用关节镜下修复（镜下组），30 例采用开放修复（开放组）。比较两组患者围手术期、随访及影像资料。[结果]两组患者均顺利完成手术，无严重并发症。关节镜组切口总长度、术中失血量、术中透视次数、下地行走时间与住院时间均显著优于开放组 （P＜0.05）。所有患者均获 12 个月以上的随访，随时间推移，两组术后踝内-外翻 ROM 及 VAS 评分均显著减少（P＜0.05），而 AOFAS 评分显著增加（P＜0.05）。术后 1 个月，镜下组踝背伸-跖屈 ROM、踝内-外翻 ROM 及 AOFAS 评分均显著优于开放组 （P＜0.05），但术后 12 个月时差异均已无统计学意义 （P＞0.05）。术后两组前抽屉试验与内翻试验均显著改善（P＞0.05），但相应时间点两组间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，术后两组应力位片距骨前移距离与距骨内翻角度均显著减少 （P＜0.05），但相同时间点两组间差异均无统计学意义 （P＞0.05）。[结论] 关节镜下改良辅助入路与开放 Brostr?m-Gould 均可有效修复慢性踝关节外侧不稳；关节镜下改良辅助入路更为微创，短期关节功能恢复疗效显著。

Abstract:

[Objective] To compare the clinical efficacy of arthroscopic versus open Brostr?m-Gould procedure for repair of anterior talofibular ligament (ATFL) in the treatment of chronic lateral ankle instability. [Methods] A retrospective study was conducted on 60 pa- tients who received surgical treatment for chronic lateral ankle instability in our hospitals from August 2018 to September 2019. According to the results of doctor-patient communication, 30 patients underwent arthroscopic repair (the arthroscopic group), while the other 30 pa- tients received open repair (the open group). The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups were operated on successfully without serious complications. The arthroscopic group proved signifi- cantly superior to the open group in terms of total incision length, intraoperative blood loss, intraoperative fluoroscopy times, postoperative walking time and hospital stay (P＜0.05). As time went during follow-up period lasted for more than 12 months, the VAS score and eversioninversion range of motion (ROM) significantly declined (P＜0.05), while the AOFAS score significantly increased in both groups (P＜0.05). At 1 month after operation, the arthroscopic group proved significantly superior to the open group in dorsal extension plantar flexion ROM, eversion-inversion ROM and AOFAS score (P＜0.05), whereas which became not statistically significant at 12 months after operation (P＞ 0.05). In addition, the anterior drawer test and varus test were significantly improved postoperatively in both groups (P＜0.05), but there was no significant difference between the two groups at any corresponding time points (P＞0.05). Regarding imaging, the anterior displacement and talus tilt under stress on X-ray films significantly decreased in both groups after operation (P＜0.05), which were not significantly differ- ent between the two groups at any matching time points (P＞0.05). [Conclusion] Both arthroscopic and open Brostr?m-Gould procedures do effectively repair chronic lateral ankle instability. In contrast, the arthroscopic procedure takes a benefit of minimally invasive surgery, which improves functional recovery in short-term.