大腓骨下骨保留联合韧带加强修复治疗儿童慢性踝关节不稳定的疗效分析

Treatment of chronic ankle instability in children with ligament reinforcement and preservation of a large subfibular bone

目的观察大腓骨下骨保留联合韧带加强修复治疗儿童慢性踝关节不稳定(CLAI)的疗效。方法回顾性分析2019年5月至2022年2月西安交通大学附属红会医院儿童骨病医院收治的43例CLAI合并腓骨下骨(最大径大于8 mm)患儿资料。男29例,女14例;年龄为(9.5±1.2)岁。根据治疗方法不同分为切除加强修复组(采用腓骨下骨切除联合韧带加强修复术治疗,19例)和保留加强修复组(采用腓骨下骨保留联合韧带加强修复术治疗,24例)。记录两组患者术前、术后即刻距骨前移距离、距骨倾斜角,术前、末次随访时美国足踝外科协会(AOFAS)的踝-后足评分、视觉模拟评分(VAS),并进行两组间比较和手术前、后比较。记录伤口愈合及并发症发生情况。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(11.6±5.8)个月。所有患者的术后即刻距骨前移距离、距骨倾斜角均较术前显著改善,所有患者的末次随访时AOFAS的踝-后足、VAS评分均较术前显著改善,差异均有统计学意义(P<0.05)。保留加强修复组患者的术后即刻距骨前移距离[5.0(4.3,5.0)mm]显著小于切除加强修复组[6.0(5.0,6.0)mm],差异有统计学意义(P=0.013)。两组患者间术后即刻距骨倾斜角、末次随访时的AOFAS的踝-后足、VAS评分比较差异均无统计学意义(P>0.05)。所有患者术后切口愈合良好,1例出现腓浅神经麻木自行恢复,考虑术中切口牵拉导致,保留加强修复组腓骨下骨均在1年内愈合。结论对于儿童CLAI合并较大直径(如大于8 mm)腓骨下骨,保留腓骨下骨联合加强修复韧带可以更好地恢复踝关节的矢状位稳定性。

Objective To investigate the effects of preserving a large subfibular bone and ligament reinforcement to treat chronic ankle instability in children.Methods A retrospective study was conducted to analyze the clinical data of qualified 43 children with chronic ankle instability and a large subfibular bone(the maximum diameter greater than 8 mm)who had been treated at Children's Osteopathy Hospital,Honghui Hospital,Xi'an Jiaotong University from May 2019 to February 2022.There were 29 boys and 14 girls with an age of(9.5±1.2)years.According to treatment methods,they were divided into group A(19 cases)where the subfibular bone was excised and the ligaments were reinforced and group B(24 cases)where the subfibular bone was preserved and the ligaments were reinforced.The talar anterior displacement and talar inclination angle at preoperation and immediate postoperation,and the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society(AOFAS)and visual analogue scale(VAS)at preoperation and the last follow-up were recorded in both groups to make comparisons between the 2 groups and between preoperation and postoperation.Wound healing and complications were also recorded.Results There was no significant difference in the preoperative general data between the 2 groups,showing comparability(P>0.05).All patients were followed up for(11.6±5.8)months.In all patients,the talar anterior displacement and talar inclination angle at immediate postoperation were significantly improved compared with the preoperation,and the ankle-hindfoot AOFAS score and VAS at the last follow-up also significantly improved compared with the preoperation(P<0.05).The talar anterior displacement at immediate postoperation in group B[5.0(4.3,5.0)mm]was significantly shorter than that in group A[6.0(5.0,6.0)mm](P=0.013).There were no significant differences between the 2 groups in the talar inclination angle at immediate postoperation,or in the ankle-hindfoot AOFAS score or VAS at the last follow-up(P>0.05).Postoperative incision healing was good in all patients.Probably due to intraoperative pulling up of the incision,superficial peroneal nerve numbness occurred in 1 case but recovered spontaneously.The subfibula bones in group B healed within 1 year.Conclusion For chronic ankle instability in children with a large subfibular bone,preservation of the subfibular bone and ligament reinforcement can better restore the ankle anteroposterior stability.