全关节镜下与改良开放式Brostrom锚钉修复距腓前韧带的疗效比较

A comparative study of all-arthroscopic technique and modified open Brostrom technique in repair of anterior talofibular ligament with anchors

目的比较全关节镜下与改良开放式Brostr?m锚钉修复距腓前韧带(anterior talofibular ligament,ATFL)治疗踝关节外侧不稳(lateral instability of the ankle,LIA)的临床疗效。方法回顾分析2014年1月-2017年1月行ATFL修复的65例LIA患者临床资料,其中全关节镜下锚钉修复35例(关节镜组),改良开放式Brostr?m锚钉修复30例(开放组)。两组患者年龄、性别、损伤侧别、受伤至手术时间以及术前卡尔森踝关节功能(KAF)评分、美国矫形足踝协会(AOFAS)评分、日本足踝外科学会(JSSF)量表评分、距骨前移、距骨倾斜角等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录2组术中出血量、手术时间、术后恢复正常生活时间,随访期间并发症发生情况。术前以及术后2周、3个月、末次随访时,X线片测量距骨前移、距骨倾斜角,KAF评分、AOFAS评分及JSSF量表评分评价踝关节功能。结果两组患者均获随访,随访时间24~30个月,平均26个月。关节镜组手术时间、术中出血量及术后恢复正常生活时间均明显优于开放组(P<0.05)。关节镜组术后出现暂时性脚踝及足背麻木2例、线头反应1例,开放组上述并发症各发生2例。术后2周,关节镜组AOFAS评分、KAF评分及JSSF量表评分均优于开放组(P<0.05);术后3个月及末次随访两组上述评分差异均无统计学意义(P>0.05)。X线片测量术后2周、3个月及末次随访时两组距骨前移和距骨倾斜角差异均无统计学意义(P>0.05)。结论与改良开放式Brostr?m锚钉修复相比,全关节镜下锚钉修复作为一种微创技术不仅能取得相似疗效,而且具有手术时间短、术中出血量少及早期疼痛轻等优势。

Objective To compare the effectiveness of all-arthroscopic technique and modified open Brostr?m technique in repair of anterior talofibular ligament(ATFL) for lateral instability of the ankle(LIA). Methods A retrospective analysis was made on 65 patients who underwent ATFL repair with anchors for LIA between January 2014 and January 2017. The ATFL was repaired by all-arthroscopic technique in 35 patients(arthroscopic group) and modified open Brostr?m technique in 30 patients(open group). There was no significant difference in age, gender, the side of injured ankle, the time from injury to operation, and preoperative anterior displacement of talus, tilt angle of talus, the Karlsson Ankle Functional(KAF) score, American Orthopaedic Foot and Ankle Society(AOFAS) score, and Japanese Society for Surgery of the foot ankle-hindfoot(JSSF) scale score between the two groups(P>0.05). The operation time, the intraoperative bleeding volume, and the length of time for surgery recovery were recorded. The anterior displacement of talus, the tilt angle of talus, KAF score, AOFAS score, and JSSF scale score were evaluated at 2 weeks, 3 months, and the last follow-up. Results All patients were followed up 24-30 months, with an average of 26 months. The operation time,intraoperative bleeding volume, and the length of time for surgery recovery of arthroscopic group were superior to open group(P<0.05). There were 2 cases of temporary ankle and dorsum numbness and 1 case of thread reaction in arthroscopic group;and there were 2 cases of temporary ankle and dorsum numbness and 2 cases of thread reaction in open group. The AOFAS score, KAF score, and JSSF scale score in arthroscopic group were significantly higher than those in open group(P<0.05) at 2 weeks after operation;there was no significant difference between the two groups at 3 months and the last follow-up(P>0.05). There was no significant difference in the anterior displacement of talus and the tilt angle of talus between the two groups at 2 weeks, 3 months, and last follow-up(P>0.05). Conclusion Compared with the modified open Brostr?m technique, the all-arthroscopic technique, as a minimally invasive technique, can achieve the same effectiveness, and has the advantages of shorter operation time, less intraoperative bleeding, and less pain in the early stage.