下胫腓增宽对慢性外侧踝关节不稳定患者术后肌力康复的影响

The effect of syndesmosis widening on postoperative muscle strength recovery in patients with lateral chronic ankle instability

目的探究下胫腓间隙增宽对慢性踝关节不稳(chronic ankle instability,CAI)患者术后肌力康复的影响。方法回顾性分析2018年3月至2020年10月在北京大学第三医院运动医学科行关节镜探查及外踝韧带修复手术的97例CAI患者资料。关节镜探查下胫腓间隙>3 mm的患者为增宽组(55例),关节镜探查下胫腓间隙≤3 mm的患者为对照组(42例)。采用Biodex测量全部患者术前及术后3个月、6个月和1年的踝关节背屈、跖屈、外翻和内翻肌力,比较两组在各时间节点的差异。结果增宽组患者术前、术后3个月及6个月的背屈肌力比对照组显著更弱(P<0.05)。术后1年,两组间的差异无统计学意义(P>0.05)。增宽组患者的术前跖屈肌力显著较强(P<0.05),但术后两组间的差异不显著(P>0.05)。增宽组患者术后1年的外翻肌力显著较弱(P=0.046)。结论与下胫腓间隙相对正常的患者相比,合并下胫腓间隙增宽的CAI患者术前及术后早期踝关节背屈肌力更弱,术后1年的外翻肌力更弱,提示需要在不同时段加强对这类患者相应肌力的训练,以促进患者康复。

Objective To investigate syndesmosis widening’s impact on postoperative muscle strength rehabilitation in chronic ankle instability(CAI)patients.Methods Retrospectively included CAI patients from March 2018 to October 2020 at Peking University Third Hospital.Based on arthroscopy(>3 mm inferior tibial-fibular space),they were categorized into widening(55 cases)and control group(42 cases).Biodex assessed ankle muscle strength at 3,6 and 12 months pre-and post-surgery,comparing values between groups.Results In the widening group,dorsiflexion strength was significantly weaker than that in the control group at 3 and 6 months(P<0.05).One year post-surgery,there was no significant difference(P>0.05).Preoperative plantarflexion strength was significantly stronger in the widening group(P<0.05).The widening group showed significantly weaker eversion strength one year after surgery(P=0.046).Conclusion CAI patients with widening inferior tibione-fibular space had weaker ankle dorsiflexion strength before and shortly after surgery,and weaker eversion strength 1 year later.The results suggested a need for targeted muscle strength training at various stages to facilitate their recovery.