摘要
目的比较关节镜下改良Broström术联合和不联合腓骨肌腱清理治疗慢性踝关节外侧不稳(CLAI)伴腓骨肌腱炎的疗效。方法采用回顾性队列研究分析2019年3月至2021年12月首都医科大学附属北京同仁医院收治的31例CLAI伴腓骨肌腱炎患者的临床资料,其中男17例,女14例;年龄16~57岁[(32.8±9.6)岁]。所有患者前抽屉试验和距骨倾斜试验为阳性。经体检及MRI明确诊断并排除跟腓韧带断裂。其中关节镜下改良Broström术联合腓骨肌腱清理11例(改良Broström术+肌腱清理组),关节镜下单纯改良Broström术20例(改良Broström术组)。比较两组手术时间、术中出血量和住院时间;术前和术后2,6,12周腓骨肌腱走行区视觉模拟评分(VAS);术前和术后6,12周美国足踝外科学会(AOFAS)踝⁃后足评分、足与踝预后量表(FAOS);末次随访时前抽屉试验;术前和末次随访时足踝功能测试(FAAM)评分。观察术后切口愈合及并发症情况。结果患者均获随访4~19个月[(11.3±3.5)个月]。改良Broström术+肌腱清理组手术时间为(66.0±4.2)min,长于改良Broström术组的(61.5±3.4)min(P<0.05)。两组术中出血量和住院时间差异无统计学意义(P均>0.05)。术后各时间点两组VAS较术前显著降低,AOFAS踝⁃后足评分、FAOS和FAAM评分较术前显著提高(P均<0.01)。两组术前VAS、AOFAS踝⁃后足评分、FAOS和FAAM评分差异无统计学意义(P均>0.05)。术后2周改良Broström术+肌腱清理组VAS为3.0(3.0,4.0)分,改良Broström术组为4.0(4.0,4.0)分(P<0.05);术后6周改良Broström术+肌腱清理组VAS为2.0(1.0,3.0)分,改良Broström术组为3.0(2.3,3.0)分(P<0.05);术后12周两组VAS差异无统计学意义(P>0.05)。术后6,12周两组AOFAS踝⁃后足评分、FAOS差异无统计学意义(P均>0.05)。末次随访时前抽屉试验均为阴性。末次随访时两组FAAM评分差异无统计学意义(P>0.05)。两组患者术后切口均Ⅰ期愈合,无感染、关节活动受限、�
Objective To compare the efficacies of arthroscopic modified Broström procedure combined with or without peroneal tendon debridement in the treatment of chronic lateral ankle instability(CLAI)concomitant with fibular tendinitis.Methods A retrospective cohort analysis was conducted on the clinical data of 31 patients with CLAI concomitant with fibular tendinitis,who were treated in Beijing Tongren Hospital,Capital Medical University between March 2019 and December 2021.The patients included 17 males and 14 females,aged 16⁃57 years[(32.8±9.6)years].The anterior drawer test and talar tilt test were positive in all patients preoperatively.Diagnosis was confirmed by physical examination and MRI,and calcaneofibular ligament rupture was excluded.Eleven patients received arthroscopic modified Broström procedure combined with peroneal tendon debridement(modified Broström procedure+tendon debridement group),and 20 underwent pure arthroscopic modified Broström procedure(modified Broström procedure group).The operation time,intraoperative blood loss and length of hospital stay were documented.The visual analogue score(VAS)in peroneal tendon area was assessed before operation and at postoperative 2,6 and 12 weeks.The American Orthopedic Foot and Ankle Society(AOFAS)ankle⁃hindfoot score and foot and ankle outcome score(FAOS)were assessed before operation and at postoperative 6 and 12 weeks.The anterior drawer test was performed at the last follow⁃up.The foot and ankle ability measure(FAAM)score was assessed before operation and at the last follow⁃up.Postoperative wound healing and complications were also observed.Results All the patients were followed up for 4⁃19 months[(11.3±3.5)months].The operation time was(66.0±4.2)minutes in the modified Broström procedure+tendon debridement group,which was significantly longer than(61.5±3.4)minutes in the modified Broström procedure group(P<0.05).There was no significant difference in intraoperative blood loss or length of hospital stay between the two groups(all P>0
作者
曲峰
孙成宜
张明珠
张琳
王智
孙超
王显军
张建中
Qu Feng;Sun Chengyi;Zhang Mingzhu;Zhang Lin;Wang Zhi;Sun Chao;Wang Xianjun;Zhang Jianzhong(Center of Foot and Ankle Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第8期680-687,共8页
Chinese Journal of Trauma
基金
北京市属医院科研培育计划项目(PX2021005)。
