关节镜联合韧带缝合治疗外踝不稳的短期疗效

Short-term efficacy of arthroscopy combined with ligament suture for chronic lateral ankle instability

目的随访采用关节镜手术联合小切口辅助下缝合距腓前韧带缝合术式治疗的患者,分析此术式治疗慢性外踝不稳的近期疗效,为进一步推广应用提供依据。方法回顾性随访自2016年1月至2018年5月,选择保守治疗无效的踝关节机械性不稳患者,排除功能性不稳、足踝部畸形等其他病史的患者。共纳入了西南医院关节外科63例应用关节镜手术联合韧带缝合术治疗慢性外踝不稳的患者。记录围手术期并发症,采用配对t检验分析术前与术后1年以上末次随访的踝关节视觉模拟疼痛(VAS)评分、美国足踝骨科协会踝与后足(AOFAS)评分。结果患者末次随访较术前踝关节VAS评分、AOFAS评分明显改善,差异有统计学意义(t=17.8、20.8,两者均P<0.01)。关节镜手术探查发现:合并软组织撞击征47例,撕脱性骨折24例,前踝骨性撞击征11例,距骨软骨损伤8例,关节游离体8例,腓骨肌腱脱位1例。患者术后均无严重并发症。结论关节镜手术联合韧带缝合术治疗慢性外踝不稳,可以获得较理想的近期疗效。该联合方案,既可以应用关节镜微创术处理踝关节内合并损伤,又可以使用锚钉技术缝合距腓前韧带,具有操作相对简单,并发症低的优势。

Objective To follow the short-term efficacy of arthroscopy combined with small incision-assisted anterior tibiofibular ligament(ATFL)suture for chronic lateral ankle instability(CLAI)to provide reference for its further application.Methods Retrospective analysis was performed in the patients with chronic lateral ankle instability from January 2016 to May 2018 who underwent arthroscopy combined with ligament suture.The patients with mechanical instability who failed conservative treatment were selected,and patients with other medical histories such as functional instability and malformation of foot and ankle were excluded.Sixty-three patients with chronic lateral malleolus instability treated by arthroscopic surgery combined with ligamentous suture were included.Perioperative complications were recorded,and paired t test was used to analyze ankle visual analog scale(VAS)score and American Orthopedic Foot and Ankle Society(AOFAS)score at the last follow-up before and after one year.Results The last follow-up showed significantly improved VAS and AOFAS scores compared with the preoperative ones,and the difference was statistically significant(t=17.8,20.8,both P<0.01).Arthroscopic probe found 47 cases of soft tissue impingement,24 case of avulsion fracture,11 cases of anterior ankle impingement,eight cases of osteochondral lesions of the talus,two cases of joint loose bodies,and one case of peroneal tendon dislocation.There was no serious postoperative complication.Conclusion Arthroscopy combined with ligament suture for CLAI which utilizes the minimally invasive arthroscopic technique to treat the intra-ankle joint combined injury and the anchor technology to suture the ATFL,has an ideal short-term efficacy and the advantages of relatively simple operation and low complications.