关节镜下Brostrom-Gould术治疗慢性踝关节外侧不稳的疗效评价

Efficacy evaluation of arthroscopic Brostrom-Gould procedure for chronic lateral ankle instability

目的探讨关节镜下Brostrom-Gould术治疗慢性踝关节外侧不稳(CLAI)的临床疗效。方法采用回顾性病例系列研究分析2016年8月—2017年7月浙江省人民医院、深圳大学附属第二医院、苏州大学骨科研究所和广州正骨医院收治的36例CLAI患者的临床资料,其中男21例(21踝),女15例(15踝);年龄18~42岁[(26.5±8.6)岁]。受伤至手术时间6~30个月[(10.8±1.6)个月]。均在关节镜下行Brostrom-Gould术(距腓前韧带修复、关节囊紧缩、伸肌下支持带加强)。记录手术时间和镜下发现的关节内病变与处理方法,观察术后切口愈合及并发症情况。比较术前、术后6周及末次随访时视觉模拟评分(VAS)、前抽屉试验、内翻应力试验、美国足踝外科协会(AOFAS)踝-后足评分、Karlsson-Peterson踝关节功能评分等。结果36例患者均获随访18~29个月[(20.5±6.3)个月]。手术时间45~115 min[(67.2±18.6)min]。术中镜下发现踝关节滑膜炎性增生35例,韧带周围瘢痕组织32例,距骨软骨损伤10例,骨赘19例,游离体5例,均得到相应治疗。术后切口均Ⅰ期愈合。无关节感染、腓浅(腓肠)神经损伤或线结刺激等并发症。2例术后踝关节内翻轻度受限,经功能康复后改善,末次随访无须行翻修手术的患者。前抽屉试验及内翻应力试验(-)。VAS术前为(5.9±1.6)分,术后6周为(1.9±1.0)分,末次随访时为(1.6±0.3)分,与术前比较差异有统计学意义(P<0.01)。AOFAS踝-后足评分术前为(67.4±7.4)分,术后6周为(89.2±6.8)分,末次随访时为(91.7±5.3)分,与术前比较差异均有统计学意义(P<0.01)。Karlsson-Peterson踝关节功能评分术前为(65.3±9.6)分,术后6周为(88.6±5.3)分,末次随访时为(90.6±3.8)分,与术前比较差异均有统计学意义(P<0.01)。结论镜下Brostrom-Gould术治疗CLAI,能可靠恢复踝外侧的稳定性,可处理关节内病变,减轻疼痛,同时术后运动能力恢复快,近期疗效满意。

Objective To investigate the clinical efficacy of arthroscopic Brostrom-Gould procedure for chronic lateral ankle instability(CLAI).Methods A retrospective case series study was conducted to analyze the clinical data of 36 CLAI patients admitted to Zhejiang Provincial People's Hospital,Second Affiliated Hospital of Shenzhen University,Institute of Orthopedics of Soochow University,and Guangzhou Orthopedic Hospital from August 2016 to July 2017.There were 21 males(21 ankles)and 15 females(15 ankles),aged 18-42 years[(26.5±8.6)years].The duration from injury to operation ranged from 6 to 30 months[(10.8±1.6)months].All patients received arthroscopic Brostrom-Gould procedure(anterior talofibular ligament repair,capsular constriction,subextensor ligament reinforcement).The operation time and arthroscopic intra-articular lesions and treatment were recorded,and the wound healing and complications were recorded.The visual analogue score(VAS),front drawer test and varus stress test results,American Orthopedic Foot and Ankle Surgery Society(AOFAS)ankle-hind foot score and Karlsson-Peterson ankle function score were compared before operation,6 weeks after operation and at the last follow-up.Results All 36 patients were followed up for 18-29 months[(20.5±6.3)months].The operation time ranged from 45 to 115 minutes[(67.2±18.6)minutes].During the operation,synovitis hyperplasia of ankle joint was found in 35 patients,scar tissue around ligament in 32,talus cartilage injury in 10,osteophyte in 19 and free body in 5,all of which were treated accordingly.All incisions were healed in the first stage after operation,without joint infection,superficial sural nerve injury or thread stimulation.The ankle varus was slightly limited in two patients after operation and improved after functional rehabilitation.No revision operation was needed at the last follow-up.Front drawer test and inverted stress test results were negative(-).The VAS score was(5.9±1.6)points before operation,(1.9±1.0)points at 6 weeks after operation,and(1.6±0.3)points at the last follow-up,with significant difference compared with that before operation(P<0.01).The AOFAS ankle-hind foot score was(67.4±7.4)points before operation,(89.2±6.8)points at 6 weeks after operation,and(91.7±5.3)points at the last follow-up,with significant difference compared with that before operation(P<0.01).Karlsson-Peterson ankle function score was(65.3±9.6)points before operation,(88.6±5.3)points at 6 weeks after operation,and(90.6±3.8)points at the last follow-up,with significant difference compared with that before operation(P<0.01).Conclusion For CLAI,the arthroscopic Brostrom-Gould procedure can treat the intra-articular lesions and reliably restore the stability of the lateral ankle.At the same time,quick motion recovery can be achieved,with satisfactory short-term curative effect.