开放与镜下Broström-Gould术修复距腓前韧带的比较

Open Brostrom-Gould procedure versus arthroscopic counterpart for repair of anterior talofibular ligament

摘要:

[目的] 比较开放与镜下 Brostr?m-Gould 术修复距腓前韧带 （anterior talofibular ligament, ATFL） 的临床效果。[方法] 回顾性分析 2019 年 1 月—2022 年 1 月本院 Brostr?m-Gould 修复慢性踝关节外侧不稳的 64 例患者的临床资料。根据术前医患沟通结果，26 例采用常规开放技术，另外 38 例采用镜下技术，比较两组围手术期、随访、影像学资料。[结果]开放组手术时间 [(64.5±10.1) min vs (57.8±6.4) min, P=0.005]、 切口长度 [(5.5±1.0) cm vs (2.9±0.7) cm, P＜0.001]、术中失血量 [(38.6±11.3) mL vs (20.1±4.0) mL, P＜0.001]、住院时间 [(7.2±1.4) d vs (4.1±1.5) d, P＜0.001] 均明显不及镜下组。随访时间平均（30.6±5.0）个月。开放组下地行走时间 [(20.7±2.1) d vs (16.9±2.0) d, P＜0.001 和完全负重活动时间 [(83.7±4.1) d vs (64.2±3.7) d, P＜0.001] 均显著晚于镜下组。与术前相比，术后 1 个月及末次随访时，两组患者前抽屉试验、内翻试验、VAS 评分、AOFAS 评分、ROM 均显著改善（P＜ 0.05）。术后 1 个月开放组 VAS [(4.6±1.5) vs (2.7±1.5), P＜0.001]、AOFAS 评分 [(74.1±8.2) vs (80.0±7.6), P=0.005] 均明显不及镜下组，术后其他相应时间点，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，术后即刻及末次随访时， 两组的内翻应力位距骨倾角（talar tilt, TT）、前抽屉应力位距骨前移度（anterior displacement, AD）、K-L（Kellgren-Lawrence）分级均显著改善（P＜0.05）。相应时间点，两组上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 镜下 Brostr?m-Gould 修复 ATFL 具有手术时间短、切口小、出血量少、术后早期疼痛较轻、功能恢复较快的优势。

Abstract:

[Objective] To compare the clinical outcomes of open Brostrom-Gould procedure versus arthroscopic counterpart for repair of the anterior talofibular ligament (ATFL). [Methods] A retrospective study was conducted on 64 patients who received Brostrom-Gould procedure for chronic lateral ankle instability in our hospital from January 2019 to January 2022. According to preoperative doctor-patient communication, 26 patients were treated with conventional open technique, while other 38 patients were treated with arthroscopic technique. The document regarding perioperative period, followup and imaging were compared between the two groups. [Results] The open group proved significantly inferior to the arthroscopic group in terms of operation time [(64.5±10.1) min vs (57.8±6.4) min, P=0.005], incision length [(5.5±1.0) cm vs (2.9±0.7) cm, P＜0.001], intraoperative blood loss [(38.6±11.3) mL vs (20.1±4.0) mL, P＜0.001], and hospital stay [(7.2±1.4) days vs (4.1±1.5) days, P＜0.001]. The average follow-up time was of (30.6±5.0) months, and the open group resumed walking [(20.7±2.1) days vs (16.9±2.0) days, P＜0.001] and full weight-bearing activity [(83.7±4.1) days vs (64.2±3.7) days, P＜0.001] significantly latter than the arthroscopic group. The anterior drawer test, inversion test, VAS score, AOFAS score and ROM in both groups were significantly improved 1 month after surgery and at the last follow-up compared with those preoperatively (P＜0.05). The VAS [(4.6±1.5) vs (2.7±1.5), P＜ 0.001] and AOFAS score [(74.1±8.2) vs (80.0±7.6), P=0.005] in the open group was significantly inferior to those in the arthroscopic group 1 month after surgery, despite of the fact that no statistical significance was noted in the above indexes between the two groups at remaining time points (P＞0.05). As for imaging, the talar tilt (TT), anterior displacement (AD) and Kellgren-Lawrence (K-L) grades in both groups were significantly improved, immediately after surgery and at the last follow-up compared with those preoperatively (P＜0.05), whereas which were not statistically significant between the two groups at any time point accordingly (P＞0.05). [Conclusion] Arthroscopic Brostrom-Gould procedure for repair of ATFL has the advantages of short operation time, small incision, less blood loss, less pain in the early postoperative period, and faster functional recovery.