关节镜下外侧韧带修复治疗慢性踝关节不稳的系统回顾

Systematic review of arthroscopic lateral ligament repair for chronic ankle instability

目的探讨关节镜下外侧韧带修复治疗慢性踝关节不稳(CAI)的可行性。方法系统检索Pub Med、EMBASE、Cochrane数据库、科学网、中国知网、维普、万方和百度学术等数据库,检索时限从建库至2018年2月,收集关节镜下外侧韧带修复治疗CAI的临床研究,结局指标包括患者术前条件、术后功能恢复、并发症等。结果共纳入16项临床研究,791例患者。9项研究报道术后平均美国矫形足与踝关节学会(AOFAS)评分达到了优(范围:90～100分),6项研究报道术后平均AOFAS评分达到了良好(范围:75～89分),没有研究报道术后平均AOFAS评分为可和差。并发症共75例,有3例患者因复发踝关节不稳再次手术。结论关节镜下踝关节外侧韧带修复可以作为一种可行的手术方案治疗CAI,但关节镜下修复可能会导致更高的并发症发生率,需更多的标本研究、临床试验和关于开放手术和关节镜手术的对照研究,以进一步评估关节镜治疗的疗效。

Objective To investigate the feasibility of chronic ankle instability (CAI) in prosthetic treatment of lateral ligament by arthroscopy. Methods We performed a systematic review of the literature using PubMed, EMBASE, Cochrane database, ScienceNet, China National Knowledge Infrastructure, VIP, Wanfang, Baidu Scholar and other databases from the date when these databases were established to February 2018. Information about clinical research on CAI in prosthetic treatment of lateral ligament by arthroscopy were collected. Outcome measures consisted of patients′ pre-operation conditions, post-operation functional recovery, complications and so on. Results A total of 791 patients were included in 16 clinical trials. It was reported in 9 researches that the score of American Orthopaedic Foot & Ankle Society (AOFAS) is excellent (range: 90-100 scores) and it was reported in 6 researches that the average score of AOFAS is good (range: 75-89 scores) and no researches indicated that the average score of AOFAS after operation was ok and poor. There were 75 complications in all in which 3 patients had second operation due to recurrence of ankle instability. Conclusion The prosthetic treatment of lateral ligament by arthroscopy can be used to cure CAI as one feasible operative plan but the repair by arthroscopy may cause higher rate of complication. Therefore, we need to carry out more researches on corpse specimen and comparative researches on clinical tests, open operation and operation by arthroscopy to further evaluate curative effects of treatment by arthroscopy.