摘要
背景:距腓前韧带是踝关节扭伤中最容易损伤的部位,甚至断裂。保守治疗无效的患者常常害怕夜间行走,出现持续性踝关节肿痛、松弛或僵硬及功能下降而引起慢性踝关节外侧不稳。为了慢性踝关节外侧不稳患者更早恢复活动功能,InternalBrace重建在不牺牲自体肌腱的同时更接近距腓前韧带的生物力学结构,使踝关节的稳定性更强。目的:通过前瞻性对照研究,评估全关节镜下距腓前韧带锚钉修复与InternalBrace重建治疗慢性踝关节外侧不稳患者的可行性及安全性,分析对比其临床疗效,为患者提供更优、更满意的全关节镜下治疗方案。方法:纳入东莞市中医院2019年1月至2021年12月收治的因距腓前韧带Ⅲ度损伤导致慢性踝关节外侧不稳患者72例,均在踝关节全关节镜下进行手术,按照前瞻性随机数字表法随机分为2组,其中InternalBrace重建组36例采用InternalBrace重建,锚钉修复组36例采用锚钉韧带残端缝合。比较两组患者术中出血量、手术时间及重返运动时间、末次随访距骨前移距离、距骨倾斜角、目测类比评分、美国足踝外科协会评分(AOFAS评分)、Kofoed踝关节功能评分、日本足踝外科学会(JSSF)量表评分及Tegner评分,并统计踝关节外侧不稳定的复发、排斥反应及伤口感染等并发症发生情况。结果与结论:①72例患者获得6-18个月随访;②InternalBrace重建组末次随访AOFAS评分、Kofoed评分、JSSF评分、Tegner评分以及距骨倾斜角、距骨前移距离较锚钉修复组明显改善(P<0.05),两组优良率达到100%;③两组患者术后均未出现踝关节外侧不稳定的复发、排斥反应及伤口感染等并发症;④两组手术出血量及手术时间、末次随访目测类比评分比较差异无显著性意义(P>0.05);⑤结果提示:对于慢性踝关节外侧不稳患者,全关节镜下InternalBrace重建强度够,稳定性可靠,踝关节功能恢复满意,能让患者得到更满意的疗效和更快重返运动。
BACKGROUND:Anterior talofibular ligament is the most easily injured or even broken of ankle sprain.Patients who fail to receive conservative treatment after injury are often afraid of walking at night,resulting in persistent ankle swelling,painful,slack or stiff and functional decline that it is so-called chronic lateral ankle instability.InternalBrace repair is closer to the biomechanical structure of anterior talofibular ligament and become stronger lateral stability of ankle that it is helpful for chronic lateral ankle instability patients who need early recovery of activity.OBJECTIVE:To investigate feasibility and safety of all-arthroscopic repair of anterior talofibular ligament with suture anchors versus InternalBrace for chronic lateral ankle instability by prospective controlled study,analyze and compare its clinical efficacy,and provide patients with better and more satisfactory total arthroscopic treatment.METHODS:From January 2019 to December 2021,72 patients with chronic lateral ankle instability induced byⅡⅡdegree injury of anterior talofibular ligament in Dongguan Hospital of Traditional Chinese Medicine were selected.Arthroscopic ankle surgery was performed.They were randomly divided into two groups according to a prospective random number table,including 36 cases repaired with InternalBrace(InternalBrace group)and 36 cases repaired with suture anchors(suture anchor group).Intraoperative blood loss,operation time,“back to sport”time,the tilt angle of talus and the anterior displacement distance of talus in last follow-up,visual analogy scale score,American Orthopaedic Foot and Ankle Society Score(AOFAS score),Kofoed ankle function score,Japanese Society for Surgery of the Foot(JSSF)scale and Tegner score were compared between the two groups.Complications such as recurrence,rejection and wound infection of lateral ankle instability were counted.RESULTS AND CONCLUSION:(1)72 patients were followed up for 6 to 18 months.(2)The AOFAS score,Kofoed ankle function score,JSSF scale and Tegner score,the tilt angle of talus and the anterior displacement distance of talus in last follow-up of InternalBrace group were significantly better than those of the suture anchor group(P<0.05),and the excellent rates both were 100%.(3)There were no complications such as recurrence of lateral ankle instability,rejection or wound infection in the two groups after surgery.(4)There was no significant difference in the intraoperative blood loss,operation time and visual analogy scale score between the two groups at the last follow-up(P>0.05).(5)It is indicated that all-arthroscopic repair of anterior talofibular ligament with InternalBrace for chronic lateral ankle instability is beneficial for sufficient strength and ankle stability.Satisfactory ankle function recovery can lead to better outcomes and faster return to sports.
作者
曾广龙
谢庆祥
李泳聪
苏博源
Zeng Guanglong;Xie Qingxiang;Li Yongcong;Su Boyuan(Dongguan Hospital(Dongguan Hospital of Traditional Chinese Medicine),Guangzhou University of Chinese Medicine,Dongguan 523000,Guangdong Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2023年第13期2064-2070,共7页
Chinese Journal of Tissue Engineering Research
基金
东莞市社会发展科技项目(20211800900062),项目负责人:苏博源。
