一种新式防撕裂(rip-stop)的距腓前韧带修复技术:生物力学和临床研究

A Novel Rip-stop Technique for Anterior Talofibular Ligament Repair:Biomechanical and Clinical Results

目的:从生物力学及临床研究方面评估一种新式的防撕裂的距腓前韧带修复技术。方法:生物力学研究方面,采用12例新鲜冷冻尸体标本随机分为2组,分别实施传统的外侧距腓前韧带(ATFL)修复技术(Brostrom repair,BR)(对照组)和新型防撕裂修复技术(实验组),然后对样本进行生物力学测试,评估并比较两组间在最终失效载荷和刚度方面有无差异。临床研究方面,将连续收治的30名慢性踝关节不稳患者纳入本研究,按照随机数字表将30例患者随机分为防撕裂修复组(实验组,15例)和传统修复组(对照组,15例),于术后2年采用美国足踝协会(AOFAS)评分、Karlsson足踝评分、Tegner评分及重返运动时间等来评估临床疗效。结果:在生物力学方面,相比于对照组,实验组显示出更高的最终失效载荷(50±11 N vs.28±4 N;P=0.001)和刚度(4±1 N/mm vs.2±2 N/mm;P=0.04),差异具有统计学意义。临床随访方面,实验组与对照组在AOFAS评分(92±5分vs.90±4分;P=0.19)、Karlsson评分(94±7分vs.93±6分;P=0.67)、Tegner活动量表(5±1分vs.5±1分;P=0.60)方面均无显著差异。与对照组相比,实验组重返运动时间显著缩短(3.6±0.6月vs.4.7±1.3月;P=0.01)。结论:与传统修复方法相比,该新式防撕裂ATFL修复技术能有效增加韧带修复后生物力学强度,并能使运动功能更早恢复。

Objective To evaluate the biomechanical properties and clinical outcomes of a novel ripstop technique for anterior talofibular ligament(ATFL)repair.Methods In the biomechanical research part,12 fresh frozen cadaver ankles were randomly allocated into a control group,subjected to traditional Brostrom repair,and an experimental group,undergoing the novel rip-stop repair.Then the maximum load-to-failure and stiffness were compared between the 2 groups.In the clinical research part,30 consecutive patients with chronic ankle instability were included in this study and were randomly divided into a rip-stop repair group and a traditional repair group,each of 15.Then,both groups were evaluated using the American Orthopaedic Foot and Ankle Society(AOFAS)score,Karlsson score and return-to-sport time.Result The experimental group showed higher ultimate failure load(50±11N vs 28±4 N,P=0.001)and stiffness(4±1 N/mm vs 2±2 N/mm,P=0.04)compared to the control group.In the clinical follow-up,there were no significant differences between the two groups in the average AOFAS score(92±5 vs.90±4,P=0.19),Karlsson score(94±7 vs.93±6,P=0.67),and Tegner activity scale(5±1 vs.5±1,P=0.60)respectively.However,the experimental group had a significantly shorter time of return-to-sport than the control group(3.6±0.6 months vs.4.7±1.3 months,P=0.01).Conclusion Compared with the traditional repair method,the new ripstop repair technique can effectively increase the biomechanical strength of ATFL and enable earlier recovery of motor function.