关节镜下Internal Brace增强术与改良Brostrom修复术治疗慢性踝关节不稳的疗效对比

Comparison of Arthroscopic Internal Brace Augmentation Versus Arthroscopic Modified Brostrom Repair Surgery for Chronic Lateral Ankle Instability

目的:比较关节镜下距腓前韧带(ATFL) Internal Brace增强术与改良Brostrom修复术治疗慢性踝关节不稳的临床疗效。方法:回顾性分析2019年7月至2021年1月42例因ATFL损伤致慢性踝关节不稳于我院行手术治疗的患者资料,根据手术方式的不同将患者分为增强组(n=19)和修复组(n=23)。比较两组患者一般资料、手术时间、韧带损伤分级、不良事件、重返日常活动和运动比例及其时间、前抽屉试验(ADT)结果、美国足踝外科协会(AOFAS)评分、疼痛视觉模拟评分(VAS)。结果:术后随访时间:修复组19.09±5.39月;增强组17.84±5.11月。两组患者年龄、性别、身体质量指数(BMI)、韧带损伤分级、手术时间差异无统计学意义(P>0.05);两组患者均未出现感染、皮肤坏死、神经血管损伤、脱钉等并发症,无二次手术。两组患者术后6周、术后6月、末次随访时VAS评分较术前明显改善(P<0.05),且增强组VAS评分在术后6周时明显优于修复组(P<0.05);但术后6月与末次随访时两组间比较差异没有统计学意义(P>0.05)。术后6周时修复组AOFAS评分与术前差异无统计学意义(P>0.05),但增强组AOFAS评分较术前明显改善(P<0.05),且组间比较增强组显著优于修复组(P<0.05);术后6月及末次随访时两组患者AOFAS评分均较术前显著改善(P<0.05),组间比较差异无统计学意义(P>0.05)。增强组重返日常生活比例在术后6周时高于修复组(P<0.05),但在6月及末次随访时两组差异无统计学意义(P>0.05);增强组重返运动比例在术后6月及末次随访时均优于修复组(P>0.05)。术后6周及6月时ADT试验均为阴性,末次随访时修复组2例ADT试验阳性,增强组均为阴性,但组间比较差异无统计学意义(P>0.05)。结论:关节镜下Internal Brace增强术与改良Brostrom修复术治疗慢性踝关节不稳均具有显著疗效,且Internal Brace增强术在早期康复和重返运动方面优于改良Brostrom修复术。

Objective To compare the clinical outcomes of anterior talofibular ligament(ATFL) arthroscopic internal brace augmentation vs arthroscopic modified Brostr?m repair surgery treating chronic lateral ankle instability. Methods Totally 42 patients who received surgical treatment for chronic lateral ankle instability caused by ATFL between July 2019 and January 2021 were selected and randomly divided into an augmentation group of 19 and a repair group of 23. The repair group received arthroscopic modified Brostr?m repair,while the augmentation group underwent arthroscopic internal brace augmentation surgery. The general condition, surgical time, arthroscopic classification for chronic ATFL tears and postoperative adverse events,as well as the time and rate of returning to normal sports and daily life were compared between the two groups. Meanwhile,both groups were evaluated using the American Orthopaedic Foot and Ankle Society(AOFAS) score,visual analog scale(VAS),and anterior drawer test(ADT). Results The repair and augmentation groups were followed up 19.09 ± 5.39 months and 17.84 ± 5.11 months. No significant difference were observed between the two groups in age,sex,body mass index(BMI),surgical time and arthroscopic classification of ATFL(P>0.05). After the operation,no complications such as skin necrosis,neurovascular injury and nail removal,as well as secondary operations were found in both groups. The average VAS score of both groups at 6 weeks and 6 months after the operation,as well as at the final follow-up,were significantly higher than before the operation(P<0.05),with that of the augmentation group 6 weeks after operation significantly higher than the repair group and no significant differences between the two group at other time points(P<0.05). Significant improvement was found in the average AOFAS score at 6 weeks postoperatively of the augmentation group,and at 6 months postoperatively and the final fellow-up in both groups(P<0.05),with that of the augmentation group significantly higher than the repair group at 6 weeks after the surgery(P<0.05). However,no significant difference between the two groups in the average AOFAS and VAS scores were observed at 6 months postoperatively and final follow-up(P>0.05). The rate of returning to daily life of the augmentation group was significantly higher than the repair group at 6weeks after surgery(P<0.05),while no significant difference was found later(P>0.05). Meanwhile,the rate of returning to sports of the augmentation group was significantly higher than the repair group at6 months postoperatively and the final fellow-up(P<0.05). The results of ADT were negative for the augmentation group at all time points,and for the repair group at 6 weeks and 6 months after surgery,with 2 positive ADT in the repair group at the final fellow-up,showing no significant differences(P>0.05). Conclusion Both the arthroscopic internal brace augmentation and modified Brostr?m repair surgery present satisfactory clinical outcomes in treating chronic lateral ankle instability,with the former superior to the latter in early rehabilitation and return to sports.