关节镜下改良Broström法治疗慢性踝关节不稳合并多韧带松弛症

Modified arthroscopic Broström procedure for the treatment of chronic ankle instability combined with multiple ligament laxity

目的探讨关节镜下改良Broström法治疗慢性踝关节不稳合并多韧带松弛症的疗效。方法采用回顾性病例系列研究分析2016年1月至2020年12月华中科技大学同济医学院附属协和医院收治的26例慢性踝关节不稳合并多韧带松弛症患者的临床资料,其中男10例,女16例;年龄18~48岁[(27.5±7.1)岁]。患者均在关节镜下行改良Broström法修复距腓前韧带(ATFL)。观察手术切口愈合情况。术前、术后3个月及末次随访时采用距骨倾斜角变化评价踝关节稳定性,采用美国足踝外科学会(AOFAS)踝‑后足评分评价踝关节功能,采用视觉模拟评分(VAS)评价疼痛改善程度。观察并发症情况。结果患者均获随访18~47个月[(25.3±8.5)个月]。手术切口均Ⅰ期愈合。距骨倾斜角由术前(15.6±4.7)°降低至术后3个月及末次随访的(4.1±1.3)°、(3.5±0.9)°(P均<0.01)。AOFAS踝‑后足评分由术前(65.8±14.5)分提高至术后3个月及末次随访的(86.5±5.6)分、(93.4±4.2)分(P均<0.01)。VAS由术前的3.0(2.0,4.0)分降至术后3个月及末次随访的1.5(0.0,2.0)分、1.0(0.0,1.2)分(P均<0.01)。与术后3个月比较,末次随访时AOFAS踝‑后足评分明显提高,VAS明显下降(P均<0.05)。1例患者术后出现腓浅神经损伤,未行特殊治疗后自行恢复。结论对于慢性踝关节不稳合并多韧带松弛症,采用关节镜下改良Broström法治疗,踝关节稳定性改善、踝关节功能恢复良好、疼痛明显缓解、术后并发症少。

Objective To investigate the effectiveness of modified arthroscopic Broström procedure for the treatment of chronic ankle instability combined with multiple ligament laxity.Methods A retrospective case series study was used to analyze the clinical data of 26 patients with chronic ankle instability combined with multiple ligament laxity treated at Union Hospital,Tongji Medical College of Huazhong University of Science and Technology from January 2016 to December 2020,including 10 males and 16 females;aged 18‑48 years[(27.5±7.1)years].All patients underwent arthroscopic repair of the anterior talofibular ligament(ATFL)by the modified Broström procedure.Healing of surgical incisions was observed after operation.The change of talus tilt angle for ankle stability evaluation,the American Orthopedic Foot and Ankle Society(AOFAS)ankle‑hindfoot score for ankle function evaluation,and the visual analogue score(VAS)for pain evaluation were assessed before operation,at 3 months postoperatively and at the last follow‑up.Complications were observed.Results All patients were followed up for 18‑47 months[(25.3±8.5)months].All surgical incisions were healed at stage I.The talus tilt angle was decreased from preoperative(15.6±4.7)°to(4.1±1.3)°and(3.5±0.9)°at 3 months postoperatively and at the last follow‑up(all P<0.01).The AOFAS ankle‑hindfoot score was improved from preoperative(65.8±14.5)points to(86.5±5.6)points and(93.4±4.2)points at 3 months postoperatively and at the final follow‑up(all P<0.01).at 3 months postoperatively and at the last follow‑up(all P<0.01).Significantly higher AOFAS ankle‑hindfoot score and lower VAS were found at the final follow‑up when compared with the scores at 3 months postoperatively(all P<0.05).One patient developed superficial peroneal nerve injury,which was recovered spontaneously without special treatment.Conclusion For chronic ankle instability combined with multiple ligament laxity,the modified arthroscopic Broström procedure has advantages of improved ankle stability,good ankle function recovery,obvious pain relief and less postoperative complications.