Internal Brace在慢性踝关节前外侧不稳术中应用的效果观察

Application of Internal Brace in treatment of chronic anterior and lateral ankle instability

目的观察Internal Brace在慢性踝关节前外侧不稳手术治疗中应用的效果。方法回顾性分析自2018-03—2020-12采用距腓前韧带Brostr?m-Gould修复联合Internal Brace加强手术治疗的19例慢性踝关节前外侧不稳,显露距腓前韧带腓骨止点足印区,韧带止点骨质表面新鲜化处理后足印区钻取骨道,置入直径4.75 mm的Swivelock可吸收锚钉,锚钉自带Internal Brace线缆带和锚钉缝合线,调整韧带张力后先用缝线缝合韧带残端,将韧带残端固定于腓骨止点;同法于距腓前韧带距骨止点钻取骨道,Internal Brace线缆带另一端引入另外1枚Swivelock可吸收锚钉,调整Internal Brace张力后将线缆带置入距骨止点骨道,最后用锚钉缝线缝合下伸肌支持带,并将其拉向腓骨。结果19例均获得随访,随访时间6~36个月,平均22.6个月。末次随访时踝与后足功能AOFAS评分90~100分,平均92.7分。19例末次随访时疼痛症状均消失,前抽屉试验与距骨倾斜试验均为阴性,患者自诉踝关节活动度基本恢复到受伤前水平,患者对日常生活、运动时踝关节功能恢复的满意度高。结论慢性踝关节前外侧不稳行Brostr?m-Gould修复联合Internal Brace加强手术可以提供可靠的即刻稳定性,合适张力的内固定线缆带安全可靠,在Internal Brace保护下有利于距腓前韧带稳定愈合,安全有效的固定有利于患者更早负重行走,更快恢复踝关节功能。

Objective To observe the effect of Internal Brace in the treatment of chronic anterior and lateral ankle instability.Methods Nineteen cases of chronic anterior and lateral ankle instability treated with the Brostr?m-Gould repair combined with Internal Brace reinforcement surgery from March 2018 to December 2020 were retrospectively analyzed.The footprint area at the fibular insertion point of the anterior talofibular ligament was exposed and treated with freshening of the ligament’s bony surface.A bone tunnel was drilled at the ligament’s insertion point,and a 4.75 mm diameter Swivelock absorbable anchor with its attached Internal Brace cable and anchor suture was inserted.After adjusting the ligament tension,the residual ligament end was sutured with the anchor suture,securing it to the fibular insertion point.The same method was applied to the talar attachment point of the anterior talofibular ligament,where a bone tunnel was drilled.The other end of the Internal Brace cable was introduced into another Swivelock absorbable anchor,and after adjusting the tension of the Internal Brace,the cable was placed into the bone tunnel at the talar attachment point.Finally,the extensor retinaculum was sutured with the anchor suture and pulled towards the fibula.ResultsAll 19 cases were followed up from 6 to 36 months,averaging 22.6 months.At the last follow-up,ankle and hindfoot function assessed by AOFAS scores ranged from 90 to 100,with an average score of 92.7.Pain symptoms disappeared in all 19 cases at the last follow-up.Anterior drawer and talar tilt tests were both negative.Patients selfreported that ankle joint mobility had largely recovered to pre-injury levels.Patients expressed high satisfaction with the restoration of ankle joint function for daily activities and physical exercises.ConclusionFor chronic anterior and lateral ankle instability,Brostr?m-Gould repair combined with Internal Brace reinforcement surgery provides reliable immediate stability,Internal Brace furthers stable healing of the anterior talofibular ligament,safe and effective fixation which facilitates earlier weightbearing walking and faster recovery of ankle function.