摘要
目的评估全镜下无结锚钉技术修复距腓前韧带治疗慢性踝关节外侧不稳定的临床疗效。方法回顾性分析2016年9月至2017年10月,采用全镜下无结锚钉技术修复距腓前韧带治疗70例慢性踝关节外侧机械性不稳患者资料,男48例,女22例;年龄18~49岁,平均(32.3±3.4)岁;受伤至手术时间6~37个月,平均18.4个月。手术采用关节镜下滑膜清理、外踝游离体取出或微骨折术,同时使用无结锚钉修复距腓前韧带,恢复踝关节稳定性。术后辅以石膏托固定,并制定相关康复计划。患者术前及末次随访时均摄踝关节前抽屉应力位X线片,测量距骨前移距离并进行统计学分析。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足功能评分评价踝关节功能,采用视觉模拟评分(visual analogue scale,VAS)评估疼痛。结果70例患者完成随访,随访时间8~18个月,平均11.5个月。所有患者切口均一期愈合,无内置物排斥反应,术后石膏固定2周,2周后进行康复训练,3个月后参加非对抗性体育锻炼,6个月后参加对抗性体育锻炼。术后1年,70例患者中,58例能满足日常生活及运动需求;7例篮球及足球爱好者诉剧烈运动后踝关节酸胀不适,经处理后症状改善;5例出现足踝部不稳定感症状改善不明显。应力位X线片示距骨前移距离由术前(11.70±1.05)mm改善为末次随访时的(3.25±1.09)mm,两者比较差异有统计学意义(t=32.15,P<0.0001)。VAS评分由术前(5.70±2.90)分降至末次随访时的(2.05±0.52)分(t=11.75,P<0.0001)。AOFAS踝-后足功能评分由术前的(54.50±7.40)分提高至末次随访时的(87.80±5.60)分(t=34.04,P<0.0001),术后优53例,良8例,可5例,差4例,优良率87.14%(61/70)。1例患者术后6个月出现踝关节跖屈时关节疼痛,复查MRI发现锚钉误入关节腔,行关节镜下凸入锚钉清理后症状缓解。结论采用全镜下无结锚钉技术修复距腓前韧带能有效恢复踝关节稳�
Objective To evaluate the clinical efficacy of total arthroscopic anterior talofibular ligament repair for chronic lateral instability of ankle joint.Methods Data of 70 patients with chronic lateral mechanical instability of ankle joint treated by anterior talofibular ligament repair under full scope from September 2016 to October 2017 were retrospectively analyzed.There were 48 males and 22 females,aging from 18 to 49 years old(average,32.3±3.4 years).Arthroscopic exploration,synovial membrane cleaning,extraction of lateral malleolus free body or microfracture were used in the operation,and the anterior talofibular ligament was repaired with knottless anchors to restore ankle stability.After the operation,plaster support was used for fixation,and relevant rehabilitation plans were conducted.X-ray films of the front drawer stress position of the ankle joint was taken preoperatively and during follow-up,and the talus advancing distance was measured preoperatively and during follow-up.Ankle function was evaluated by American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot function score,and pain was evaluated by visual analogue scale(VAS).Results Seventy patients were followed up for 8-18 months,with an average of 11.5 months.The incisions of all patients were healed in one stage without internal plant rejection reaction.The plaster was fixed for 2 weeks after operation,followed by rehabilitation training 2 weeks later,non-confrontational physical exercise 3 months later and confrontational physical exercise 6 months later.Within one year after operation,58 patients could meet the needs of daily life and exercise.Seven basketball and football fans complained of ankle joint soreness and discomfort after strenuous exercise,and the symptoms were relieved after treatment.The symptoms of foot and ankle instability were not significantly improved in 5 patients.Stress X-ray showed that the talus advancing distance was improved from 11.70±1.05 mm before operation to 3.25±1.09 mm at the latest follow-up,and t
作者
张宇
王勇
张文举
徐善强
李平
Zhang Yu;Wang Yong;Zhang Wenju;Xu Shanqiang;Li Ping(The 2nd Department of Foot and Ankle,Sichuang Provincial Orthopaedic Hospital,Chengdu 610041,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2019年第9期525-531,共7页
Chinese Journal of Orthopaedics
