急性踝关节外侧副韧带撕裂后锚钉固定与单纯缝合的中长期疗效比较

Comparison of suture anchor and simple suture for acute injury to lateral ankle ligament: mid-to long-term outcomes

目的比较急性严重踝关节外侧副韧带撕裂(接近韧带止点处的马尾状撕裂)后采用锚钉固定与单纯缝合术后的中长期疗效。方法回顾性分析2007年6月至2017年5月北京大学第三医院运动医学科接受急性踝关节外侧副韧带撕裂(接近韧带止点处的马尾状撕裂)修复手术的146例患者资料。男101例, 女45例;年龄(27.1 ± 10.3)岁(12~62岁)。根据修复方法不同分为锚钉组(81例, 对撕裂韧带采用1.8 mm带线锚钉重建)和缝合组(65例, 对撕裂韧带采用编织线直接缝合)。比较两组患者术前和末次随访时疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)的踝-后足评分、Tegner评分, 以及术后恢复运动的时间和程度、关节活动受限率、再次扭伤率及患者满意度。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05), 具有可比性。所有患者术后随访时间为(46.1 ± 14.1)个月(36~132个月)。所有患者末次随访时VAS评分、AOFAS的踝-后足评分、Tegner评分均较术前显著改善, 差异有统计学意义(P<0.05)。两组患者末次随时VAS评分、AOFAS评分、Tegner评分、再次扭伤率、关节活动受限率比较差异均无统计学意义(P>0.05)。锚钉组比缝合组恢复运动的程度更高(92%±13%vs. 89%±13%), 恢复运动的时间更早[4.2±1.1)个月vs.(4.6±1.0)个月〗, 差异均有统计学意义(P<0.05)。结论韧带修复无论采用锚钉固定还是单纯缝合, 对于运动要求较高的急性严重踝关节外侧副韧带撕裂患者是一种可靠的手术, 但锚钉固定相较于单纯缝合可使患者更早重返运动。

Objective To compare the mid-to long-term clinical outcomes between suture anchor and simple suture for acute injury to lateral ankle ligament(cauda equina tear near the insertion).Methods This retrospective study included 146 patients(professional and semi-professional athletes)who had been treated for acute injury to lateral ankle ligament(cauda equina tear near the insertion)at Department of Sports Medicine,The Third Hospital Affiliated to Peking University from June 2007 to May 2017.They were 101 males and 45 females,with an age of(27.1±10.3)years(from 12 to 62 years).Depending on ligament repair techniques,the patients were divided into a suture anchor group of 81 cases subjected to reconstruction of the torn ligament with a 1.8 mm suture anchor,and a simple suture group of 65 cases subjected to direct suture of the torn ligament with a braided thread.The 2 groups were compared in terms of visual analog scale(VAS)pain scores,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot scores and Tegner scores at preoperation and the last follow-up,time and level of postoperative motion recovery,proportion of limited joint motion,incidence of re-sprain and patient satisfaction.Results There was no significant difference in the preoperative general data between the 2 groups,showing they were comparable(P>0.05).The mean follow-up duration was(46.1±14.1)months(from 36 to 132 months).The VAS pain score,AOFAS ankle-hindfoot score and Tegner score at the last follow-up were significantly improved than those before operation in all the patients(P<0.05).Postoperatively,there was no significant difference between the 2 groups in VAS pain score,AOFAS ankle-hindfoot score,Tegner score,incidence of re-sprain or proportion of limited joint motion(P>0.05).The suture anchor group was significantly better than the simple suture group in the level of postoperative motion recovery(92%±13%versus 89%±13%)and time of postoperative motion recovery[(4.2±1.1)months versus(4.6±1.0)months](P<0.05).Conclusions Ligament repair,either by suture anchor or by simple suture,is a reliable procedure for patients with high sports demands after severe acute injury to the lateral ankle ligament.Compared with simple suture,suture anchor may accelerate postoperative motion recovery to the pre-injury level.