开放与关节镜下改良Brostr?m术式治疗慢性踝关节外侧副韧带损伤的对比研究

Comparing Open and Arthroscopic Modified Brostr?m Procedures for the Treatment of Chronic Lateral Ankle Ligament Injury

目的:比较开放与关节镜下改良Brostr?m术式修复慢性踝关节外侧副韧带损伤的临床疗效。方法:自2015年1月~2017年6月共收治40例踝关节外侧副韧带损伤患者,对所有患者进行临床和影像学评估,证实其踝关节外侧副韧带损伤,分为开放组(22例)和关节镜组(18例)。所有患者在术前及术后6周、6月、12月及末次随访中使用美国骨科足踝协会(AOFAS)评分,在术前及术后1周、1月、6月及末次随访中使用视觉模拟疼痛评分(VAS)比较手术疗效。结果:两组患者年龄、性别、随访时间和手术时间差异无统计学意义(P>0.05);关节镜组手术切口长度小于开放组(P<0.001)。两组患者术后AOFAS和VAS评分与术前相比,差异均有统计学意义(P<0.05)。术后6周关节镜组AOFAS评分高于开放组(P<0.05);术后1周关节镜组VAS评分低于开放组(P<0.05)。两组患者均未出现皮肤坏死、血管损伤、感染等并发症,开放组出现2例神经损伤,关节镜组出现1例。所有患者术后12周均能达到受伤前的运动水平。结论:关节镜下改良Brostr?m术式治疗慢性踝关节外侧副韧带损伤短期疗效优于切开术式,但长期疗效相似。关节镜下改良Brostr?m术式具有微创、快速康复等优点。

Objective To compare the clinical result of open and arthroscopic modified Brostr?m pro cedure(MBP)in the treatment of chronic lateral ankle ligament injury(CLALI).Methods Totally 40 pa tients diagnosed as CLALI clinically and imageologically between January 2015 and June 2017 were se lected and randomly divided into an open MBP group(n=22)and an arthroscopic MBP group(n=18).The American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hind foot score was used to evaluate both groups before,as well as 6 weeks,6 and 12 months after the operation and during the last fol low-up,while the visual analog scale(VAS)was implied before,as well as 1 week,1 and 6 months after the operation and during the last follow-up.Results There were no significant differences between the two groups in the age,gender,follow-up time and operative time(P>0.05),while the average length of incision of the arthroscopic group was significantly shorter than the open group(P<0.001).Sig nificant improvement was observed in the average AOFAS and VAS scores after the procedures for both groups,with the average AOFAS of the arthroscopic group 6 months after the operation signifi cantly higher than the open group,and the average VAS score of the former group one week after the surgery significantly lower than the latter group(P<0.05).There was no occurrence of complications such as skin necrosis,vascular injury and infection in both groups.There were 2 cases of nerve inju ry in the open group but 1 in the arthroscopic group.Twelve weeks after the operation,all patients re covered their normal sports level.Conclusion The arthroscopic modified Brostr?m procedure is superior to open MBP in short term,but have the same effect with the latter in the long run.Therefore,it is more of minimally invasive and rapid recovery.