距腓前韧带/跟腓韧带解剖重建与改良Brostrom法治疗慢性踝关节外侧不稳定对比观察

Anatomical reconstruction of anterior talofibular ligament/calcaneofibular ligament and modified Brostrom method in the treatment of chronic lateral ankle instability

目的对比距腓前韧带/跟腓韧带解剖重建与改良Brostrom法治疗慢性踝关节外侧不稳定的效果。方法选取2015年2月至2017年2月在我院就诊的慢性踝关节外侧不稳定患者26例为研究对象,根据随机数字表法分为A组和B组,各13例。A组采用距腓前韧带/跟腓韧带解剖重建治疗,B组采用改良Brostrom法紧缩缝合治疗,术后随访2年,对比两组视觉模拟评分法(visual analogue scale,VAS)评分、美国足踝外科学会(American Orthopaedic Foot&Ankle Society,AOFAS)评分、距骨倾斜、前抽屉试验及踝关节相关指标。结果A组术后AOFAS评分高于B组,差异有统计学意义(P<0.05);两组术后VAS评分及踝关节跖屈比较,差异无统计学意义(P>0.05);A组术后距骨倾斜、前抽屉试验及踝关节内翻均低于B组,差异有统计学意义(P<0.05);两组术后均未出现皮缘坏死、感染及神经损伤等并发症,且术后2年内无不稳定复发情况。结论相较于修复治疗,距腓前韧带/跟腓韧带解剖重建可更好地恢复踝关节外侧稳定性。

Objective To compare the effects of anterior talofibular ligament/calcaneofibular ligament reconstruction and modified Brostrom method in the treatment of chronic lateral ankle instability.Methods Selection From February 2015 to February 2017,26 patients with chronic lateral instability of ankle joints were divided into group A and group B according to random number table.13 cases each.Anatomical reconstruction of anterior talofibular ligament/calcaneofibular ligament was used in group A,and tightening suture was used in group B.The patients were followed up for 2 years.Visual analogue scale(VAS),American Academy of Foot and Ankle Surgery(AOFAS),talus tilt,anterior drawer test and ankle related indicators were used in group A.Results A The AOFAS score in group A was higher than that in group B,with significant difference(P<0.05);there was no significant difference in VAS score and ankle metatarsal flexion between the two groups(PAfter operation,talus tilt,anterior drawer test and ankle varus in group A were lower than those in group B(P<0.05),and there was significant difference between the two groups(P<0.05).There were complications such as skin edge necrosis,infection and nerve injury,and there was no unstable recurrence within 2 years after operation.Conclusion Compared with repair,anterior talofibular ligament/calcaneofibular ligament Anatomical reconstruction can better restore lateral stability of ankle joint.