一期韧带修复联合拉力螺钉固定治疗踝关节不稳的疗效观察

Efficacy of phase Ⅰ ligament repair combined with lag screw fixation for ankle instability

目的探讨一期韧带修复联合拉力螺钉固定治疗踝关节不稳的临床疗效。方法回顾性分析2011年1月至2013年6月间我科收治的34例急性踝关节外侧扭伤患者,男18例,女16例,年龄28.0~69.0岁,平均(49.3±1.9)岁。随机分为螺钉固定组和外固定组,每组各17例,分别采用一期带线铆钉原位修补联合拉力螺钉固定(螺钉固定组)和石膏或支具外固定治疗(外固定组)。所有患者术后患肢不负重,随访3个月,观察两组住院费用及并发症发生情况,根据美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分及视觉模拟评分法(visual analogue score,VAS)评价两种方法的治疗效果。结果螺钉固定组住院费用为(1.72±0.30)万元,外固定组为(0.68±0.20)万元,差异有统计学意义(P<0.05)。术后1、2、3个月随访AOFAS踝与后足评分,螺钉固定组为(66.2±1.3)分、(88.5±2.1)分、(97.2±1.9)分,外固定组为(46.8±1.6)分、(53.5±2.7)分、(75.6±1.2)分,差异有统计学意义(P<0.05)。采用VAS评分:螺钉固定组为(3.2±0.8)分、(2.5±0.6)分、(1.2±0.2)分,外固定组为(4.0±0.7)分、(3.1±0.6)分、(2.6±0.4)分,差异有统计学意义(P<0.05)。螺钉固定组所有患者术后未发生螺钉切出、断钉、创伤性关节炎、下胫腓不稳等并发症,外固定组中2例出现踝关节僵硬,经功能锻炼和物理疗法后有所缓解,4例术后3个月因疼痛和踝关节不稳二期行韧带重建术,恢复可。结论一期韧带修复联合拉力螺钉固定治疗急性踝关节不稳虽然住院费用较高,但并发症少,术后踝关节功能佳,是临床治疗踝关节扭伤的一种可行术式。

Objective To evaluate the clinical efficacy of phase I ligament repair combined with lag screw fixation for ankle instability. Methods From Jan. 2011 to Jun. 2013, 34 patients with acute ankle sprain, including 18 males and 16 females, aged 28.0 to 69. 0 years （mean 49. 3 years）, were ran- domly divided into external fixation group and screw fixation group （n = 17 each）, given external fixation with plaster or brace, and phase I line of rivets in-situ repair combined with lag screw, respectively. All lesion limbs were not weight-bearing and followed up for 3 months. Hospital costs and complications were observed. Therapeutic effect was evaluated by AOFAS and VAS score. Results The cost of hospitalization was （1.72 ± 0. 3{）） ten thousand yuan in screw fixation group, and （0. 68 ± 0. 20） ten thousand yuan in external fixation group （P〈0. 05）. AOFAS scores at I st, 2nd, and 3rd month during the followed-up period were （66. 2 ± 1.3）, （88.5 ± 2. 1） and （97. 2 ± 1.9） in screw fixation group, and （46. 8 ± 1.6）, （53.5 ± 2. 7） and （75.6 ± 1.2） in external fixation group （P〈0. 05）, respectively. VAS scores at 1st, 2nd, and 3rd month during the followed-up period were （3.2 ± 0. 8）, （2. 5 ± 0. 6） and （1.2 ± 0. 2） in screw fixation group, and （4. 0 ± 0. 7）, （3. l ± 0. 6） and （2.6 ± 0. 4） in external fixation group （P^0. 05）, respectively. There was no screw cut out, nails broken, traumatic arthritis, inferior tibiofibular instability and other complications in screw fixation group. In external fixation group, 2 patients complained of ankle stiffness that eased after exercise and physiotherapy, and 4 patientsadministered phase Ⅱ ankle ligament reconstruction due to pain and instability in the knee. Conclusion Phase I ligament repair combined with lag screw fixation for acute ankle instability manifests excellent postoperative ankle function and fewer complications, although the cost of hospitalization is higher. It is a practicable procedure for ankle sprains.