关节镜下修复慢性踝关节不稳的近期疗效

Arthroscopic repair of chronic ankle instability:preliminary results

目的探讨关节镜下Brostrom术治疗慢性踝关节不稳的近期疗效。方法回顾性分析2016年3月至12月期间武汉市第四医院足踝外科应用关节镜治疗的17例(17踝)慢性踝关节不稳患者资料。男5例,女12例;年龄为18~52岁,平均28岁;左踝9例,右踝8例。术前诊断慢性踝关节不稳,术中采用全关节镜下Brostrom术修复距腓前韧带。比较患者术前与末次随访时的美国足踝外科协会(AOFAS)的踝-后足评分、距骨前移距离、距骨倾斜角及疼痛视觉模拟评分(VAS)等。结果17例患者术后获平均12个月(10~18个月)随访。术后所有患者均未发生伤口感染。1例患者发生腓浅神经麻痹,未经处理,自行恢复。末次随访时AOFAS的踝-后足评分由术前(47.5±3.4)分提高至(95.7±2.1)分,距骨前移距离由术前(10.12±3.23)mm减小至(4.02±1.68)mm,距骨倾斜角由术前15.20°±3.43°减少至6.02°±2.64°,VAS评分由术前(5.7±1.8)分降至(1.6±1.4)分,以上项目术前与末次随访时比较差异均有统计学意义(P<0.05)。结论应用关节镜Brostrom术修复慢性踝关节不稳可以很好地恢复踝关节的稳定性,且创伤小,近期疗效满意。

Objective To evaluate the efficacy of arthroscopic Brostrom technique in the treatment of chronic ankle instability.MethodsSeventeen patients with chronic ankle instability were treated at Department of Foot and Ankle Surgery, Wuhan Fourth Hospital from March to December 2016. They were 5 males and 12 females, aged from 18 to 52 years (mean, 28 years). The ankle instability confirmed preop-eratively involved the left side in 9 cases and the right side in 8 ones. Arthroscopic Brostrom technique was used to repair the anterior talofibular ligament. All the patients were evaluated preoperatively and at the last follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). The talar tilt angle and anterior translation were also assessed radiographically in pre-and postoper-ative ankle stress views.ResultsThey obtained a mean follow-up of 12 months (range, from 10 to 18 months). Wound infection occurred in none of the patients;paresthesia appeared in the superficial fibular nerve area in one case which was recovered spontaneously. At the last follow-up, their AOFAS scores were improved from preoperative 47.5±3.4 to 95.7±2.1, VAS pain scores were decreased from preoperative 5.7±1.8 to 1.6±1.4, anterior talar translation was reduced from preoperative 10.12±3.23 mm to 4.02±1.68 mm, and talar tilt angle decreased from 15.20°±3.43° to 6.02°±2.64°. All the above differences were statistically significant(P<0.05).ConclusionArthroscopic Brostrom technique may be consid-ered as a valid option for treatment of chronic ankle instability, because it can well restore the stability of ankle joint and lead to satisfactory short-term results.