全踝关节镜下距腓前韧带一期修复术治疗新鲜外踝撕脱骨折

Treatment of the fresh lateral malleolus avulsion fracture by using the all ankle arthroscope for anterior talofibular ligament repairing

目的探讨全踝关节镜下距腓前韧带一期修复术治疗新鲜外踝撕脱骨折的临床疗效。方法回顾性分析2016年1月—2017年3月徐州市中心医院手足显微外科全踝关节镜下治疗的36例36足新鲜外踝撕脱骨折患者的临床资料。其中男22例、女14例,年龄18~57(29.24±10.37)岁;右侧20例,左侧16例。患者均采用全踝关节镜下距腓前韧带带线锚钉一期修复治疗,术后定期门诊随访,观察踝关节外观、踝关节稳定性及行走步态等;末次随访采用视觉模拟评分(VAS)、美国骨科足踝外科协会(AOFAS)评分及足踝部Olerud-Molander评分对手术治疗效果进行评价。患者术前VAS为5~8(6.35±1.17)分,AOFAS评分为60~85(74.67±8.36)分,Olerud-Molander评分为57~80(68.89±10.70)分。结果所有患者手术切口一期愈合,无一例出现神经、血管、肌腱损伤等并发症。36例患者获得随访,随访时间12~25(14.63±6.80)个月。末次随访时,患侧踝关节外观恢复满意,无感觉过敏现象及瘢痕触痛,踝关节恢复正常活动,无关节痛及关节不稳情况,均恢复正常行走步态;末次随访时VAS、AOFAS及Olerud-Molander评分分别为(0.31±0.14)、(90.40±9.62)、(88.71±7.38)分,与术前比较差异均有统计学意义(t=30.755、7.405、9.149,P值均<0.05)。结论采用全踝关节镜下一期修复距腓前韧带,具有安全可靠、疗效确切、创伤小等优点,是新鲜外踝撕脱骨折的有效治疗方法。

Objective To investigate the therapeutic efficacy of treating fresh lateral malleolus avulsion fracture by using the all ankle arthroscope for anterior talofibular ligament repairing. Methods From January 2016 to March 2017, 36 patients (36 ankles) of fresh lateral malleolus avulsion fracture were retrospectively followed in Xuzhou Central Hospital. There were 22 males and 14 females, aged from 18 to 57 years with a median of (29.24±10.37) years. Among them, the right and the left sides were involved in 20 and 16 cases, respectively. All the patients were treated by using the all ankle arthroscopy technique combined with anchor fixation for anterior talofibular ligament repairing. The appearance of the ankle, the stability of the ankle joint and the walking gait were observed after the operation. The effect of the operation was evaluated by visual analogue scale(VAS), American Orthopaedic Foot and Ankle Society(AOFAS) and Olerud-Molander scores at the last follow-up. The preoperative VAS, AOFAS and Olerud-Molander scores were 5-8(6.35±1.17), 60-85(74.67±8.36) and 57-80(68.89±10.70), respectively. Results The incision healed by first intention, without evidence of postoperative complications of nerve, vessel and tendon injury. Thirty-six patients were successfully followed up for 12 to 25 months (average 14.6±6.80 months). At the final follow-up, no case reported skin hyperalgesia or scar tenderness, the perfect skin appearance, normal ankle function and normal walking gait were regained in all the cases without ankle pain and bearing walking pain. At the final follow up, the scores of the VAS, AOFAS, and Olerud-Molander were(0.31±0.14),(90.40±9.62) and (88.71±7.38), which were statistically different from those before surgery (t=30.755, 7.405 and 9.149, all P values<0.05). Conclusions Treatment of anterior talofibular ligament injury with all ankle arthroscopy procedure has the advantages of safety, reliability, effectiveness and small trauma. It is an effective method for the treatment for the avulsion fracture of the lateral malleolus of the anterior talofibular ligament.