镜下确诊下胫腓联合不稳经皮Tightrope修复的意义△

Significance of Tightrope repair for distal tibiofibular syndesmosis instability diagnosed under arthroscopy

摘要:

[目的] 探讨对踝关节镜诊断的下胫腓联合不稳采用 Tightrope 修复的临床意义。[方法] 2017 年 11 月—2020 年 3 月，对 41 例踝关节镜下确诊下胫腓联合不稳患者行经皮 Tightrope 修复。评价临床与影像资料。[结果]41 例患者均顺利完成手术，切口均 I 期愈合。所有患者随访 24~52 个月，平均随访时间(35.4±7.7)个月，随访过程中，41 例患者均未出现切口感染、神经血管损伤、下肢静脉血栓形成等并发症，均未行翻修手术。随时间推移 (术前、术后 6、12 个月和末次随访)，VAS 评分显著减少 [(4.4±2.8), (2.6±1.8), (1.8±1.6), (1.4±1.5), P＜0.001]，而 AOFAS 评分 [(60.9±28.6), (73.4±13.9), (82.2±14.0), (85.0±10.0), P＜0.001] 和 SF-36 评分 [(89.5±12.1), (98.8±12.9), (106.8±12.0), (112.2±13.4), P＜0.001] 显著增加；但是，踝关节跖屈-背伸和旋前旋后活动度无显著变化 (P＞0.05)。至末次随访时，39 例恢复伤前运动水平，占 95.1%。影像方面，随时间推移，踝内侧间隙 (medial clear space, MCS)、胫腓间隙 (tibiofibular clear space, TFCS)、胫腓重叠 (tibiofibular overlap, TFO) 均无显著改变 (P＞ 0.05)。[结论] 踝关节镜检查是发现远端胫腓联合不稳定的有效工具，采用经皮 Tightrope 修复下胫腓联合不稳可获得满意疗效。

Abstract:

[Objective] To investigate the clinical significance of percutaneous repair with Tightrope for distal tibiofibular syndesmosis instability diagnosed by ankle arthroscopy. [Methods] From November 2017 to March 2020, 41 patients received percutaneous Tightrope repair for distal tibiofibular syndesmosis instability that was found under ankle arthroscopy. The clinical and imaging documents were evalu- ated. [Results] All the 41 patients had operation completed with incisions healed in stage I, whereas without complication such as incision infection, neurovascular injury and lower limb deeper venous thrombosis. All patients were followed up for 24~52 months, with an average follow-up time of (35.4±7.7) months. During the follow-up, none of the 41 patients had complications such as incision infection, neurovas- cular injury, venous thrombosis of lower limbs and revision surgery. With time elapsed in points preoperatively, 6 months postoperatively, 12 months postoperatively and the latest follow- up, the VAS score significantly reduced [(4.4±2.8), (2.6±1.8), (1.8±1.6), (1.4±1.5), P＜ 0.001], while the AOFAS score [(60.9±28.6), (73.4±13.9), (82.2±14.0), (85.0±10.0), P＜0.001] and SF-36 score [(89.5±12.1), (98.8±12.9), (106.8±12.0), (112.2±13.4), P＜0.001] significantly increased, however, the ankle plantar flexion-dorsal extension range of motion (ROM) and pronation-supination ROM remained unchanged (P＞0.05). By the last follow-up, 39 patients regained the pre-injury exercise level, ac- counting for 95.1%. In terms of imaging, medial clear space (MCS), tibiofibular clear space (TFCS), tibiofibular overlap (TFO) was not signif- icantly changed (P＞0.05). [Conclusion] The ankle arthroscopic examination is efficient tool to find distal tibiofibular syndesmosis instabili- ty, while percutaneous Tightrope repair of distal tibiofibular syndesmosis instability does achieve satisfactory clinical outcomes in this study.