带线锚钉修复治疗合并腓骨尖撕脱骨折的距腓前韧带损伤后踝关节不稳的临床疗效观察

Clinical effect of repairing ankle instability after talofibular ligament injury combined with avulsion fracture of fibula tip

目的观察带线锚钉修复治疗合并腓骨尖撕脱骨折的距腓前韧带损伤后踝关节不稳的疗效。方法回顾性分析南华大学附属第一医院2019年1月—2020年4月收治的15例合并腓骨尖撕脱骨折的距腓前韧带损伤踝关节不稳患者,所有患者均行踝关节镜探查清理,外踝小切口切开行带线锚钉修复距腓前韧带止点撕脱骨折。术前、术后随访采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分评价足部的功能;术前、术后采用视觉模拟评分(visual analogue scale,VAS)评价踝部疼痛;通过X线片观察距骨前移距离(anterior talar translation,ATT)、距骨前移率(ΔATT)以及距骨倾斜角(talar tilt,TT)。结果15例患者术后随访4~26个月,平均随访(10.2±3.7)个月,AOFAS术前评分为43~75分,平均(63.5±2.8)分;术后评分为87~98分,平均(94.8±2.6)分,通过术前术后AOFAS评分比较,差异有统计学意义(P<0.01);最近一次随访,AOFAS评分优12例,良2例,可1例,优良率达93.8%。VAS疼痛评分由术前(7.4±0.5)分改善至术后(2.9±0.6)分,差异有统计学意义(P<0.01)。术前与术后两组间跖屈内翻TT值由(17.4°±3.2°)改善至(5.3°±1.8°),背屈内翻TT值由(11.7°±5.9°)改善至(2.8°±1.5°);术前与术后ΔATT由(23.8%±5.7%)改善至(11.9%±4.6%),差异有统计学意义(P<0.01)。患者术后无不稳定感,随访期间未发现踝关节不稳复发。结论采用带线锚钉修复治疗合并腓骨尖撕脱骨折的距腓前韧带损伤后踝关节不稳,可恢复踝关节功能及稳定性,手术操作简单、创伤较小,疗效显著。

Objective To observe the curative effect of ankle instability after talofibular ligament injury combined with avulsion fracture of fibula tip with suture anchor repair.Methods Retrospective analysis of the First Affiliated Hospital of University of South China between January 2019 and April 2020 were 15 cases of avulsion fracture of the fibula tip talofibular ligament damage before patients with ankle instability,all patients were performed ankle probe the clear mirror,external ankle operation with small incision line anchor nail repair avulsion fracture talofibular ligaments before check point.The foot function was evaluated by the American Orthopaedic Foot and Ankle Society(AOFAS)foot function scoring system.Ankle pain was assessed by visual analogue scale(VAS)before and after surgery.Anterior talar translation(ATT),anterior talar translation rate(ΔATT)and talar tilt(TT)were measured by X-ray.Results The 15 patients were followed up for 4~26 months,with an average follow-up of(10.2±3.7)months.The preoperative AOFAS score ranged from 43 to 75,with an average preoperative score of(63.5±2.8)points.Postoperative scores ranged from 87 to 98,with an average of(94.8±2.6)points,and the difference was highly statistically significant(P<0.01)by comparing preoperative and postoperative AOFAS scoring system.In the last follow-up,12 cases had excellent AOFAS scores,2 cases were good,and 1 case was fair,with an excellent and good rate of 93.8%.The VAS score of ankle pain improved from(7.4±0.5)points before surgery to(2.9±0.6)points after surgery,and the difference was statistically significant(P<0.01).Before and after operation,the TT value of plantar varus was improved from(17.4°±3.2°)to(5.3°±1.8°),and the TT value of dorsiflexor varus was improved from(11.7°±5.9°)to(2.8°±1.5°).ΔATT was improved from(23.8%±5.7%)to(11.9%±4.6%),and there was a significant difference between preoperative and postoperative(P<0.01).The patient had no sense of instability after surgery and no recurrence of ankle instability was found during the follow-up period.Conclusion Anchor repair with thread for ankle instability caused by talofibular ligament injury combined with avulsion fracture of fibula tip can restore the function and stability of the ankle joint.It is a significant clinical treatment method with simple operation and less trauma.The treatment of ankle joint instability has obvious curative effect.