改良全关节镜下三入路法重建踝关节距腓前韧带的疗效分析

Analysis of the efficacy of modified total arthroscopic three-approach reconstruction of the anterior talofibular ligament of the ankle

目的评价改良全关节镜下三入路法重建踝关节距腓前韧带(anterior talofibular ligament,ATFL)的临床疗效。方法回顾性分析2018年6月至2019年12月在我院治疗的26例慢性踝关节外侧不稳定患者,均采用改良全关节镜下三入路法进行ATFL重建。手术先行踝关节镜探查关节腔情况,然后通过三个小切口作为入路的方法制备骨隧道、后用挤压螺钉固定方法重建ATFL。通过术前、术后的疼痛视觉模拟评分(visual analogue scale,VAS)和美国骨科足踝外科协会(Fellowship of American College of Foot and Ankle Surgery,AOFAS)评分,评价该术式疗效。结果术后所有患者均获得随访,VAS评分从术前的(3.04±0.82)分下降至术后的(0.49±0.40)分,AOFAS评分由术前(60.19±7.79)分升至术后(94.15±5.07)分,差异有统计学意义(P<0.05)。本组26例患者术后均未出现皮肤麻木不适、伤口感染、关节僵硬黏连,也无踝关节不稳复发,仅1例诉腓骨后侧短时间疼痛不适,理疗后缓解。结论改良全关节镜下三入路法重建踝关节ATFL,镜下视野好,皮肤切口更少,可避免开放手术造成的皮肤瘢痕黏连,皮下硬结,线头异物反应等,术后患者体验更好,是治疗踝关节前外侧慢性不稳定一种安全、有效的方法。

Objective To evaluate the clinical effect of modified total arthroscopic three-approach reconstruction of the anterior talofibular ligament(ATFL)of the ankle.Methods A total of 26 patients with chronic lateral ankle instability,treated in our hospital from June 2018 to December 2019,were retrospectively analyzed.All patients underwent modified three-approach arthroscopic reconstruction of the anterior talofibular ligament(ATFL).The ankle arthroscope was used to explore the joint cavity.Bone tunnel was prepared through three small incisions,and the anterior talofibular ligament was reconstructed by extrusion screw fixation.Preoperative and postoperative VAS scores and AOFAS scores were used to evaluate the efficacy of the operation.Results All patients were followed up after operation.VAS pain score decreased from(3.04±0.82)before operation to(0.49±0.40)after operation,and AOFAS score increased from(60.19±7.79)before operation to(94.15±5.07)after operation;the differences were statistically significant(P<0.05).None of the 26 patients had skin numbness,wound infection,joint stiffness,adhesion or ankle instability.Only 1 patient complained of short-term pain and discomfort of the posterior fibula,which was relieved after physical therapy.Conclusions Modified three-approach method under total arthroscopy has good visual field and less skin incision in the reconstruction of the anterior talofibular ligament of the ankle,which will avoid skin scar adhesion,subcutaneous induration and foreign body reaction caused by open surgery.It is a safe and effective method for the treatment of chronic instability of the anterolateral ankle joint.