踝旋转损伤镜下一期修复距腓前韧带和三角韧带（开放获取）

Simultaneous arthroscopic repair of anterior talofibular ligaments and deltoid ligaments for ankle rotation injuries

摘要:

[目的] 探讨关节镜辅助一期修复距腓前韧带（anterior talofibular ligament, ATFL） 与三角韧带（deltoid ligament,DL） 治疗踝关节旋转不稳定的的短中期疗效。[方法] 回顾性研究2018 年1 月—2021 年12 月本院采用镜下一期修复ATFL 和DL，并随访资料完整的18 例患者。评估术前及末次随访的临床和影像资料。[结果] 18 例患者均顺利完成手术，手术时间（56.7±7.2） min；术中失血量（9.4±1.4） mL；下地行走时间（14.9±0.5） d。所有切口均为一期甲级愈合，无切口深部感染，术中无重要血管、神经损伤等严重并发症，随访（16.4±2.1） 个月。与术前相比，末次随访时AOFAS 评分[(65.1±8.3), (93.7±4.4),P＜0.001] 和踝背伸-跖屈ROM [(61.3±3.7)°, (68.0±2.3)°, P＜0.001] 显著增加；而疼痛VAS 评分[(3.8±1.0), (0.7±0.7), P＜0.001] 和踝内-外翻ROM [(47.2±2.2)°, (44.2±1.7)°, P＜0.001] 显著减小。此外，与术前相比，末次随访患者踝关节的抽屉试验、外翻试验及内翻试验均显著改善（P＜0.001）。影像方面，与术前相比，末次随访时的距骨小腿角（talocrural angle, TCA） 和内侧间隙（me-dial clear space, MCS） 均无显著变化（P＞0.05）。所有患者均出现踝关节明显退行性改变。[结论] 关节镜辅助下一期修复ATFL与DL 能够有效改善踝关节旋转不稳定。

Abstract:

[Objective] To investigate the short and medium term outcome of arthroscope-assisted repair of the anterior talofibular liga-ment (ATFL) and deltoid ligament (DL) simultaneously for rotational instability of the ankle. [Methods] A retrospective study was conduct-ed on 18 patients who had ATFL and DL repaired simultaneously under arthroscope in our hospital from January 2018 to December 2021,with complete follow-up data. The clinical and imaging data were evaluated at the time points preoperatively and at the latest follow-up.[Results] All the 18 patients had operation performed successfully with the operation time of (56.7±7.2) min, intraoperative blood loss of(9.4±1.4) mL, ambulation time of (14.9±0.5) days. All patients got incisions healed well without major neurovascular injury, deep incisioninfection, or other serious complications, and followed up for a mean of (16.4±2.1) months. Compared with those preoperatively, the AOFASscore [(65.1±8.3), (93.7±4.4), P＜0.001] and ankle dorsal extension-plantar flexion ROM [(61.3±3.7)°, (68.0±2.3)°, P＜0.001] increasedsignificantly; while pain VAS score [(3.8±1.0), (0.7±0.7), P＜0.001] and ankle inversion-eversion ROM [(47.2±2.2)°, (44.2±1.7)°, P＜0.001] significantly decreased at the latest follow-up. In addition, the ankle anterior drawer test, valgus test, and varus test significantly im-proved at the last follow-up compared with the preoperative test (P＜0.001). As for imaging, there were no significant changes in talocruralangle (TCA) and medial clear space (MCS) at the last follow-up (P＞0.05). All patients had no significant degenerative changes in the anklejoint. [Conclusion] The simultaneous arthroscopic ATFL and DL repair do effectively improve the rotational instability of the ankle.