慢性踝关节不稳定840例韧带损伤类型的超声评估

Ultrasonic Evaluation for Injury Patterns of Ankle Lateral Ligaments in 840 Patients with Chronic Lateral Ankle Instability

目的:通过对华山医院840例慢性踝关节不稳定患者踝关节超声图像的调查明确其韧带损伤类型及各损伤类型的流行病学特点,为临床诊断和手术治疗慢性踝关节不稳定提供参考依据。方法:回顾性纳人本院自2016年1月至2018年2月收集的840例慢性踝关节不稳定患者踝关节軔带损伤的超声图像,采用t检验和精确Fisher检验对患者的人口学资料及患侧分类进行统计分析,损伤类型结果以百分数呈现。结果:在840个病例中,单纯距腓前軔带损伤占47.9%(402/840),距腓前初带损伤合并胫腓韧带损伤占8.1%(68/840),距腓前韧带合并跟腓韧带损伤占44.0%(370/840);在370例合并损伤病例中,16.8%(62/370)的患者表现为距腓前韧带被完全吸收,其中19.4%(12/62)的患者跟腓初带也被吸收;在所有外侧韧带损伤病例中跟腓靭带出现吸收的比例较低(25/840=3.0%)。结论:在慢性踝关节不稳定中,超声检查发现跟腓韧带被完全吸收的病例并不常见,即使当距腓前靭带被吸收后,也只有大约1/5的跟腓軔带需要重建,并不需要在所有的踝关节外侧韧带手术中都常规修复或重建跟腓籾带。

Purpose:Using the ankle ultrasound imaging of 840 chronic lateral ankle instability(CAI)patients in Huashan Hospital to assess the injury patterns and the prevalence of each type of injuries,which provide a reference for clinical diagnosis and surgical treatment of CAI.Methods:This retrospective study included the ultrasound images of 840 cases with ankle ligament injury from January 2016 to February 2018.The patients'demographic data and injury location were recorded and analyzed using t-test and Fisher's exact test.The injury patterns were presented as proportion.Results:Of the 840 CAI patients,47.9%(402/840)suffered from anterior talofibular ligament(ATFL)injury alone,8.1%(68/840)suffered from ATFL and tibiofibular ligament camplex injury,and that of ATFL and calcaneofibular ligament(CFL)complex injury patients was found in 44.0%(370/840).Among the 370 complex injury,16.8%(62/370)presented with an absorbed ATFL and 19.4%(12/62)presented with an absorbed CFL.The total CFL absorption proportion in all patients was relatively low(25/840=3.0%).Conclusion:Ultrasound found that total absorption injury patterns of the CFL in CAI are not common.Even when the ATFL is absorbed,only approximately one fifth of CFLs require reconstruction,suggesting that there is no need to routinely repair or reconstruct CFLs in all lateral ligament surgeries.