关节镜下Brostr?m法结合Gould技术治疗距腓前韧带损伤

Application of Brostr?m Method Combined With Gould Technique Under Arthroscope in the Treatment of Anterior Talofibular Ligament Injury

目的探讨关节镜下Brostr?m法结合Gould技术治疗踝关节距腓前韧带损伤的临床疗效。方法 2009年3月~2015年10月,我科对17例距腓前韧带损伤采用关节镜下Brostr?m法结合Gould技术,利用带线锚钉加强缝合修复距腓前韧带,同时微创紧缩缝合伸肌支持带,加强踝关节外侧稳定性,通过疼痛及不稳症状改善情况,距骨倾斜角变化,美国足踝关节协会(American Orthopaedic Foot&Ankle Society,AOFAS)评分,行走时疼痛视觉模拟评分(Visual Analogue score,VAS)评分评价手术效果。结果 17例随访10~18个月(平均12个月)。术前AOFAS总评分(44.2±3.7)分,术后1、3、6、10个月AOFAS总评分分别为(49.4±4.1)、(70.7±5.4)、(82.1±4.1)、(92.0±5.0)分,与术前比较均显著升高(P=0.015,P=0.000,P=0.000,P=0.000)。术前VAS评分为(7.1±1.4)分,术后1、3、6、10个月分别为(7.2±1.5)、(4.8±1.1)、(2.1±0.9)、(1.3±0.7)分,除术后1个月以外,其余与术前比较均显著降低(P=0.001,P=0.000,P=0.000)。术前距骨倾斜角为8.8°±0.6°,术后1、3、6、10个月分别为4.1°±0.4°、3.5°±0.8°、3.2°±0.6°、3.2°±0.7°,与术前比较均显著变小(P=0.000,P=0.000,P=0.000,P=0.000)。结论关节镜下Brostr?m法结合Gould技术治疗踝关节距腓前韧带损伤疗效满意,值得推广。

Objective To investigate the clinical effect of Brostr？m method combined with Gould technique under ankle arthroscope for the anterior talofibular ligament injury. Methods From March 2009 to October 2015,seventeen patients with anterior talofibular ligament injury were treated by knitting the lateral collateral ligament through the Brostr？m method combined with Gould technique under ankle arthroscope. Suture anchors were used for strengthening suture of the anterior talofibular ligament,and minimally invasive tight suture was applied to the ligament of extensors to improve the external stability of ankle. The pain extent,joint instability,talar tilt angle,American Orthopaedic Foot Ankle Society（ AOFAS） scores,and Visual Anologue Score（ VAS） were used in postoperative follow-ups to assess the clinical outcome. Results The 17 patients were followed up for 10-18 months（ mean,12 months）. After the operation,all the patients obtained a significant improvement of pain and instability. The AOFAS score was（ 44. 2 ± 3. 7） points and the VAS scores were（ 7. 1 ± 1. 4） points before operation. The AOFAS total scores at 1,3,6,and 10 month after operation were（ 49. 4 ± 4. 1）,（ 70. 7 ± 5. 4）,（ 82. 1 ± 4. 1）,and（ 92. 0 ± 5. 0） points,respectively,which were significantly higher than preoperation（ P = 0. 015,P = 0. 000,P = 0. 000,and P = 0. 000）. The VAS scores at 1,3,6,and 10 month after operation were（ 7. 2 ± 1. 5）,（ 4. 8 ± 1. 1）,（ 2. 1 ± 0. 9）,and（ 1. 3 ± 0. 7） points,respectively. Except for the VAS scores at the first postoperative month,the scores at other 3 time points were significantly lower than preoperation（ P = 0. 001,P =0. 000,P = 0. 000）. The talar tilt angle reduced from 8. 8° ± 0. 6° preoperatively to 4. 1° ± 0. 4°,3. 5° ± 0. 8°,3. 2° ± 0. 6°,and3. 2° ± 0. 7°at 1,3,6,and 10 month after operation,which were significantly lower than preoperation（ P = 0. 000,P = 0. 000,P =0. 000,P = 0. 000）. Conclusions For those patients with anterior talofibular ligament injury,the Brostr？m method combined with Gould technique under ankle arthroscope has good clinical effect. It is worth to be popularized.