Internal brace与带线锚钉通过改良Broström术治疗慢性踝关节不稳的疗效对比

Clinical and functional results of modified Broström procedure with internal brace versus suture anchor for chronic lateral ankle instability

目的比较internal brace(IB)与带线锚钉通过改良Broström术治疗慢性踝关节不稳的临床疗效。方法回顾性分析2019年5月至2022年2月在桂林市人民医院本院关节骨科行手术治疗的42例慢性踝关节外侧不稳患者资料,根据距腓前韧带修补所用材料的不同将患者分为IB组(19例)和带线锚钉组(23例)。比较两组患者一般资料、手术时间、并发症发生率、术后完全负重行走时间、术后恢复跑步的时间、美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分、视觉模拟评分法(visual analog scale,VAS)评分。结果所有患者术后均获得随访,随访时间12~18个月,平均(13.8±5.3)个月。两组患者基线资料差异无统计学意义(P>0.05);两组各有1例术口拆线后再出现渗液,换药后愈合;两组各有2例术口区域感觉障碍,除IB组有1例术后半年仍未完全恢复外,其余3例术后2~3个月恢复;IB组患者术后6周随访时AOFAS评分优于带线锚钉组,差异有统计学意义(t=2.239,P=0.025),但术后6周时VAS评分比较差异无统计学意义(t=0.308,P=0.760);末次随访时AOFAS评分和VAS评分比较,两组之间差异无统计学意义(t=0.045,P=0.965;t=0.203,P=0.840);IB组术后完全负重行走时间、术后恢复跑步的时间显著早于带线锚钉组,差异有统计学意义(t=26.566,P<0.01;t=4.838,P<0.01)。结论IB与带线锚钉通过改良Broström术开放治疗慢性踝关节不稳的临床疗效满意,且使用IB在早期康复和重返运动方面优于带线锚钉。

Objective To compare the results of modified Broström procedure with internal brace versus suture anchor for chronic lateral ankle instability(CLAI).Methods Totally 42 patients who received surgical treatment for CLAI in the Department of Joint Orthopedics of Guilin People’s Hospital between May 2019 and February 2022 were selected and divided into IB group(n=19)and suture anchor group(n=23)according to the materials used for anterior talofibular ligament repair.The general condition,surgical time,complications,as well as the time of returning to normal sports and daily life were compared between the two groups.Meanwhile,both groups were evaluated using the American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot function scale and visual analog scale(VAS).Results All patients were followed up for 12~18 months,with an average follow-up of(13.8±5.3)months.No significant differences were observed between the two groups in baseline data(P>0.05).There was 1 patient in each group who reported wound exudation after suture removal,which healed after dressing changes;and 2 patients in each group developed sensory disturbance around the operation area;except for 1 patient in IB group who did not completely recover in 6 months after surgery,the other 3 patients recovered 2~3 months after operation.The AOFAS scores of the IB group was significantly higher than the suture anchor group at 6 weeks postoperatively(t=2.239,P=0.025).The VAS scores of the two groups at 6 weeks postoperatively has no significant difference(t=2.239,P=0.025).There were no significant differences between the two groups in AOFAS scores and VAS scores were observed at final follow-up(t=0.045,P=0.965;t=0.203,P=0.840).The time of returning to normal sports and daily life of IB group was significantly earlier than that of suture anchor group(t=26.566,P<0.01;t=4.838,P<0.01).Conclusion Both the internal brace and suture anchor present satisfactory clinical outcomes for chronic lateral ankle instability through a mini open modified Broström procedure,and the internal brace group superior to the suture anchor group in early rehabilitation and return to sports.