关节镜下Brostrom-Gould修复术联合人工韧带加强治疗距腓前韧带损伤

Effect of arthroscopic augmention using suture-tape for Brostrom-Gould repair of anterior talofibular ligament injury

目的探讨全关节镜下Brostrom-Gould修复术联合使用Internal Brace人工韧带治疗超重及韧带质量欠佳人群距腓前韧带损伤的临床疗效。方法回顾性分析2017年10月至2018年5月,采用关节镜下Brostrom-Gould修复术联合使用Internal Brace人工韧带治疗12例距腓前韧带损伤患者资料,男7例,女5例;年龄16~57岁,平均32.4岁;体重指数28.0~30.7 kg/m^2,平均(28.8±0.91)kg/m^2;其中韧带质量欠佳(Beighton评分≥4)2例。所有患者均有踝关节不稳症状,前抽屉试验及距骨倾斜试验均为阳性。患者在全关节镜下将1枚带有Internal Brace人工韧带及不可吸收缝线的直径4.75 mm锚钉置入腓骨止点处,首先用该锚钉上的不可吸收线行标准Brostrom-Gould术式修复距腓前韧带,再于镜下将线带另一端固定于距骨止点稍远端附近。比较手术前后美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分、足踝功能测试(foot and ankle ability measure,FAAM)评分。结果术后患者切口均一期愈合,无一例发生感染。12例患者均获得随访,随访时间7~12个月,平均9.1个月。患者2周后开始功能锻炼并佩戴护踝支具下地。末次随访时,前抽屉试验及距骨倾斜试验均为阴性。患踝关节AOFAS踝-后足评分由术前(61.3±7.9)分提高到末次随访时的(85.0±6.0)分;FAAM评分由术前(57.5±10.1)分提高到末次随访时的(86.3±4.8)分;两评分术前及术后比较,差异均有统计学意义(t=21.422和15.032,均P<0.01)。根据AOFAS踝-后足评分,优1例,良11例,优良率100%(12/12);术后无一例发生感染、再断裂等并发症。结论对于超重或韧带质量欠佳的距腓前韧带损伤患者,无需另取肌腱重建,全关节镜下Brostrom-Gould修复术联合使用Internal Brace人工韧带治疗可取得良好的疗效。

Objective To evaluate the short-term efficacy of Brostrom-Gould repair combined with Internal Brace artificial ligament reinforcement under arthroscopy for anterior talofibular ligament injury in overweight and poor ligament quality population.Methods A total of 12 patients with anterior talofibular ligament injury treated by arthroscopy were enrolled from October 2017 to May 2018,involving 7 males and 5 females aged from 16 to 57 years old(mean 32.4 years).Patients were with ankle instability,and their BMI was 28.0-30.7 kg/m^2(average,28.8±0.91 kg/m^2),among which there were 2 cases of poor ligament quality(Beighton score≥4).The anterior tibiofibular ligament injury and the quality of the ligament stump were intraoperatively evaluated under arthroscopy.A 4.75 mm diameter anchor with Internal Brace artificial ligament was inserted into the fibula insertion site,and non-absorbable suture was placed at the talus under total arthroscopy.Firstly,the non-absorbable line on the anchor was performed under the standard Brostrom-Gould procedure to repair the anterior talofibular ligament,and the other end of the ligament was fixed near the distal end of the talus.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and foot and ankle ability measure(FAAM)was compared before and after surgery.Results All the incisions were healed in the first stage after operation,and no operative complications such as infection occurred.All the 12 patients were followed up for 7 to 12 months(average 9.1 months).After 2 weeks,the patient began functional exercise and could walk with ankle braces.At the latest follow-up,the anterior drawer test was negative.The ankle-posterior foot score of AOFAS was increased from 61.3±7.9(preoperative)to 85.0±6.0(latest follow-up)(t=21.422,P<0.01),and the FAAM score was increased from 57.5±10.1(preoperative)to 86.3±4.8(latest follow-up)(t=15.032,P<0.01).AOFAS score was excellent in 1 case and good in 11 cases.The excellent and good rate was 100%(12/12).No complications such as infection and re-rupture occurred after operation.Conclusion For anterior talofibular ligament injury patients with overweight or poor quality of ligament,the Brostrom-Gould procedure can be applied to strengthen under arthroscopic Internal Brace ligament without additional tendon reconstruction,which can also obtain good results.