摘要
目的探究关节镜下修复距腓前韧带(ATFL)和跟腓韧带(CFL)治疗慢性踝关节外侧不稳(CLAI)合并距下关节不稳(STI)的临床效果。方法本研究为回顾性病例系列研究。回顾性分析2019年1月至2022年12月于苏州大学附属第二医院手足外科行关节镜手术治疗的15例CLAI合并STI患者的临床资料。男性11例,女性4例,年龄(28.6±1.5)岁(范围:19~39岁)。右侧9例,左侧6例。所有患者术前拍摄踝关节内翻应力位X线片并行MRI检查,术中在关节镜下采用拉索技术分别行ATFL和CFL修复术。术后1年复查MRI,记录患肢功能恢复情况,采用疼痛视觉模拟评分(VAS)、美国足踝外科协会踝与后足评分(AOFAS-AH)及Karlsson踝关节功能评分(KAFS)评估患肢疼痛和功能情况。手术前后数据比较采用配对样本t检验。结果所有患者均获随访,随访时间(23.6±2.3)个月(范围:12~30个月),切口均一期愈合,未发生血管神经损伤、感染等并发症。末次随访时,AOFAS-AH由术前的(50.5±11.7)分升至(94.2±6.1)分(t=-13.132,P<0.01);KAFS由术前的(44.3±10.8)分升至(90.8±6.4)分(t=-12.510,P<0.01);VAS由术前的(6.1±1.4)分降至(1.4±1.2)分(t=9.482,P<0.01),差异均有统计学意义。结论采用关节镜技术修复ATFL和CFL可恢复患者踝关节和距下关节稳定性,且操作简便、创伤小、患者术后恢复快,为临床治疗CLAI合并STI提供了一种新思路。
Objective To investigate the clinical efficacy of simultaneous arthroscopic repair of anterior talofibular ligament(ATFL)and calcaneofibular ligament(CFL)for treating chronic lateral ankle instability(CLAI)in conjunction with subtalar instability(STI).Methods This is a retrospective case series study.The clinical data of 15 patients with ankle arthroscopic in the Department of Hand and Foot Surgery,the Second Affiliated Hospital of Soochow University from January 2019 to December 2022 were analyzed retrospectively.There were 11 male cases and 4 female cases,aged(28.6±1.5)years(range:19 to 39 years).All the patients were evaluated by manual inversion stress X-ray and MRI before operation.Arthroscopically observing and then repairing the ATFL and CFL separately after further diagnostic confirmation.One year after operation,MRI was performed,and pain visual analogue score(VAS),American Orthopedic Foot and Ankle Society ankle hindfoot scale(AOFAS-AH)and Karlsson ankle functional scale(KAFS)were evaluated.Data were compared using paired sample t test.Results The follow-up period was(23.6±2.3)months(range:12 to 30 months).At last follow-up,the VAS decreased from 6.1±1.4 preoperatively to 1.4±1.2(t=9.482,P<0.01).The AOFAS-AH improved from 50.5±11.7 preoperatively to 94.2±6.1(t=-13.132,P<0.01),and the KAFS improved from preoperatively 44.3±10.8 to 90.8±6.4(t=-12.510,P<0.01).There was no complication such as recurred instability or joint stiffness.Conclusions Arthroscopically repairing the ATFL and CFL separately can effectively restore the stability of the ankle and subtalar joint with small trauma.Patients can recover quickly after surgery.It provides a new idea for the clinical treatment of CLAI combined with STI.
作者
毛伟伟
汤骏杰
张勇
李伟
祝蓥
王颖
桂鉴超
秦建忠
Mao Weiwei;Tang Junjie;Zhang Yong;Li Wei;Zhu Ying;Wang Ying;Gui Jianchao;Qin Jianzhong(Department of Hand and Foot Surgery,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Jiangsu Taihu Compulsory Isolation and Rehabilitation Center,Suzhou 215111,China;Suzhou Medical College,Soochow University,Suzhou 215006,China;Department of Wound Center,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Orthopedics,Nanjing First Hospital,Nanjing 210012,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2024年第6期565-571,共7页
Chinese Journal of Surgery
基金
苏州大学放射医学与辐射防护国家重点实验室(GZK1202303)
苏州大学附属第二医院核技术医学应用重点人才项目(XKTJ-HRC2021005)。
关键词
踝关节
关节不稳定性
距下关节不稳
慢性踝关节外侧不稳定
跟腓韧带
距腓前韧带
关节镜
韧带修复
Ankle joint
Joint instability
Subtalar instability
Chronic lateral ankle instability
Calcaneofibular ligaments
Anterior talofibular ligament
Arthroscopic
Ligament repair
