关节镜下韧带增强固定与改良...不稳定患者踝关节功能的影响_赵廷虎.pdf

第 39 卷第 2 期2023 年 2 月长春中医药大学学报Journal of Changchun University of Chinese MedicineVol.39 No.2Feb.2023192 DOI:10.13463/ki.cczyy.2023.02.018关节镜下韧带增强固定与改良 Brostrom 术对慢性踝关节外侧不稳定患者踝关节功能的影响赵廷虎1，李 彦2（1.深圳市骨伤科医院/深圳市坪山区中医院足踝外科，广东 深圳 518010；2.深圳市骨伤科医院/深圳市坪山区中医院创伤科，广东 深圳 518010）摘要：目的 对比关节镜下韧带增强固定与改良 Brostrom 术对慢性踝关节外侧不稳定患者踝关节功能的影响。方法 选择慢性踝关节外侧不稳定患者 80 例，按随机数表法分为改良 Brostrom 术组、关节镜下韧带增强固定组，各 40 例。改良Brostrom术组给予改良Brostrom术治疗，关节镜下韧带增强固定组给予关节镜下韧带增强固定治疗，2组术后均随访1年。比较2组围手术期指标，术前、术后1年踝关节影像学指标，多时间点足与踝功能（FAAM）、美国矫形外科足踝协会（AOFAS）踝与后足功能评分，随访 1 年切口愈合、复发情况。结果 关节镜下韧带增强固定组术中出血量低于改良 Brostrom 术组，术后下床时间、手术时间、恢复正常生活时间短于改良 Brostrom 术组（P 0.05）。术后 1 年，2 组距骨倾斜角、距骨前移距离较术前降低，且关节镜下韧带增强固定组低于改良 Brostrom 术组（P 0.05）。与术前比较，2 组术后 6 个月、术后 1 年 FAAM（日常运动、体育运动）、AOFAS 踝与后足功能评分均呈升高趋势，且术后 6 个月、术后 1 年关节镜下韧带增强固定组 FAAM（日常运动、体育运动）、AOFAS 踝与后足功能评分高于改良 Brostrom 术组（P0.05）。随访 1 年，2 组甲级愈合、乙级愈合比例比较，差异无统计学意义（P0.05），关节镜下韧带增强固定组复发率低于改良 Brostrom 术组（P 0.05）。结论 与改良 Brostrom 术比较，关节镜下韧带增强固定治疗慢性踝关节外侧不稳定可改善患者围手术期指标，促进踝关节功能恢复，优化踝关节影像学指标，降低复发风险。关键词：慢性踝关节外侧不稳定；关节镜下韧带增强固定；改良 Brostrom 术；踝关节功能；踝关节影像学指标中图分类号：R687.4 文献标志码：A 文章编号：2095-6258(2023)02-0192-05Comparison of the effects of an arthroscopic ligament augmentation and fixation and a modified Brostrom operation on the ankle function in patients with chronic lateral ankle instabilityZHAO Tinghu1,LI Yan2(1.Foot and Ankle Surgery Department,Shenzhen Orthopedics Hospital/Shenzhen Pingshan Hospital of Traditional Chinese Medicine,Shenzhen 518010,China;2.Trauma Department,Shenzhen Orthopedics Hospital/Shenzhen Pingshan Hospital of Traditional Chinese Medicine,Shenzhen 518010,China)Abstract:Objective To compare the effects of an arthroscopic ligament augmentation and fixation and a modified Brostrom operation on the ankle function in patients with chronic lateral ankle instability.Methods A total of 80 patients with chronic lateral ankle instability treated in our hospital from January 2019 to January 2021 were divided into a modified Brostrom operation group and an arthroscopic ligament augmentation and fixation group by the random number table method,with 40 cases in each group.The modified Brostrom operation group was treated with modified Brostrom operations,while the arthroscopic ligament 基金项目：广东省中医药局科研项目（20211353）作者简介：赵廷虎（1981），男，硕士，副主任医师，主要从事足踝创伤与慢性病临床研究第 39 卷第 2 期2023 年 2 月长春中医药大学学报Journal of Changchun University of Chinese MedicineVol.39 No.2Feb.2023193augmentation and fixation group was treated with the arthroscopic ligament augmentation and fixation.Both groups were followed up for one year after operation.The perioperative indexes,ankle imaging indexes before operation and after one year of operation,the scores of the Foot and Ankle Ability Measure(FAAM)and the ankle and hindfoot function by the American Orthopedic Foot and Ankle Society(AOFAS)at diff erent time points,and the wound healing and recurrence after one-year follow-up were compared between the two groups.Results The intraoperative blood loss in the arthroscopic ligament augmentation and fixation group was lower than that in the modified Brostrom operation group,and the postoperative ambulation time,operation time,and the time to return to normal life were shorter than those in the modified Brostrom operation group(P0.05).One year after operation,the talus inclination angle and the talus anterior displacement in the two groups were lower than those before operation,and the arthroscopic ligament augmentation and fi xation group was lower than the modified Brostrom operation group(P0.05).Six months and one year after operation,the scores of FAAM(daily exercise,sports)and the AOFAS ankle and hindfoot function were increased in both groups,and the scores in the arthroscopic ligament augmentation and fi xation group were higher than those in the modifi ed Brostrom operation group(P0.05),while the recurrence rate of the arthroscopic ligament enhancement and fixation group was lower than that of the modified Brostrom operation group(0.00%vs 15.00%,P0.05).Conclusion Compared with the modifi ed Brostrom operation,the arthroscopic ligament augmentation and fixation in the treatment of chronic lateral ankle instability can improve the perioperative indexes,promote the recovery of the ankle function,optimize the ankle imaging index,and reduce the risk of its recurrence.Keywords:chronic lateral ankle instability;arthroscopic ligament augmentation and fixation;modified Brostrom operation;ankle function;ankle imaging index 慢性踝关节外侧不稳定为骨科常见疾病，患者运动功能受到严重影响，可出现慢性疼痛、反复扭伤等，如未及时治疗还可能发展为骨关节炎症1-3。慢性踝关节外侧不稳定主要病因为踝关节受到外力扭转、撞击后未得到有效治疗4-5。手术为其有效的治疗方案，但任何踝关节面结构轻微异常均可能影响术后踝关节运动度。改良 Brostrom 术为慢性踝关节外侧不稳定的常用治疗方案，可对距腓前韧带损伤进行修复，提高患者运动功能。研究6-7显示，改良 Brostrom 术作为开放术式，仍存在损伤较大、不能达到解剖重建的缺陷。随着微创技术及理念进步，关节镜被引入到慢性踝关节外侧不稳定的治疗中，关节镜下韧带增强固定通过缝合带对距腓前韧带损伤进行加强，收紧固定锚钉尾部缝合带可改善关节稳定度。目前，关节镜下韧带增强固定与改良 Brostrom 术治疗慢性踝关节外侧不稳定的优劣尚未完全明确。本研究选择慢性踝关节外侧不稳定患者 80 例，对比关节镜下韧带增强固定与改良 Brostrom 术对慢性踝关节外侧不稳定患者踝关节功能的影响，报道如下。1 资料与方法1.1 一般资料 选择 2019 年 1 月 2021 年 1 月我院收治的慢性踝关节外侧不稳定患者 80 例，采用随机数表法分为改良 Brostrom 术组和关节镜下韧带增强固定组，各 40 例。改良 Brostrom