“三明治”术式联合关节镜治疗踝关节慢性不稳的临床疗效

Clinical effect of“sandwich”operation combined with arthroscopy on chronic ankle instability

目的探讨“三明治”术式联合关节镜探查清理治疗慢性踝关节不稳的临床疗效。方法回顾性分析2017年4月—2019年10月陆军第八十一集团军医院骨科收治的64例慢性踝关节不稳患者资料。其中男性56例,女性8例(其中男性军人20例,女性军人3例);年龄18~35岁,平均25.2岁。致伤原因为军事训练伤、运动伤及生活中扭伤。深层采用距腓前韧带(anterior talofibular ligament,ATFL)缝合修复固定,中层用人工线带加强固定,表层采用伸肌支持带与腓骨膜缝合加强的“三明治”术式联合关节镜探查修复。手术前后采用美国足踝外科协会(AOFAS)踝-后足功能评分量表评分和视觉模拟评分(VAS)评价踝关节功能和疼痛。结果64例术后随访10~15个月,平均12.5个月。术后患者切口均无感染,术后2周开始完全负重,4周开始恢复慢跑,3个月后开始运动竞技。AOFAS踝-后足功能评分从术前的(55.6±8.5)分提高到术后的(87.5±5.2)分,而VAS从术前的(4.5±1.4)分降至(1.5±0.4)分(P<0.05)。末次随访时行踝关节前抽屉试验和距骨倾斜试验,均显示阴性。结论“三明治”术式联合关节镜治疗慢性踝关节不稳,临床疗效显著,具有较高的临床推广应用价值。

Objective To investigate the clinical effect of“Sandwich”operation combined with arthroscopy in the treatment of chronic ankle instability.Methods The data of 64 patients with old ankle sprain admitted to the Department of Orthopaedics of Army 81th Group Army Hospital from Apr.2017 to Oct.2019 were retrospectively analyzed.There were 56 males and 8 females.There were 20 male soldiers and 3 female soldiers.The age ranged from 18 to 35 years,with an average of 25.2 years.The main injury causes were summarized as follows:military training injuries,sports injuries,sprains.They were repaired and fixed by suture of anterior talofibular ligament(ATFL),artificial suture band at the middle layer,and“sandwich”combination of extensor support band and fibular membrane suture at the surface.Ankle function and pain were assessed by the American Association of Foot and Ankle Surgery(AOFAS)ankle-posterior foot scale and visual analog scale(VAS)before and after surgery.Results The 64 cases were followed up for 10-15 months,with an average of 12.5 months.No incision infection was found in the patients after surgery.The patients started full weight-bearing 2 weeks after surgery,resumed jogging 4 weeks after surgery,and began sports competition 3 months later.AOFAS scores increased from preoperative(55.6±8.5)points to postoperative(87.5±5.2)points,while VAS decreased from preoperative(4.5±1.4)points to(1.5±0.4)points(P<0.05).The anterior ankle drawer test and talus tilt test were negative at the last follow-up.Conclusion“Sandwich”operation combined with arthroscopy in the treatment of chronic ankle instability has a significant clinical effect and has a high value of clinical application.