慢性踝关节外侧不稳关节镜下与切开重建外侧副韧带的疗效比较

Comparing open and arthroscopic anatomic ligament reconstruction for chronic lateral ankle ligament injury

目的:比较全关节镜下及切开行距腓前韧带(anterior talofibular ligament,ATFL)和跟腓韧带(calcaneofibular ligament,CFL)重建的临床疗效。方法:回顾性分析2017年1月~2021年7月我科收治的51例慢性踝关节外侧不稳(chronic lateral ankle instability,CLAI)患者的临床资料。24例行全关节镜下ATFL及CFL重建,27例行常规切开ATFL及CFL重建。比较两组手术时间、术中并发症、住院时间、恢复正常行走时间等围手术期资料。术后行CT检查评估骨道位置。对比患者术前、术后3个月、术后6个月、术后1年及2年随访的美国足踝外科学会评分(American Orthopedic Foot and Ankle Society Score,AOFAS)、Karlsson评分、疼痛视觉模拟评分(visual analogue scale,VAS),抽屉试验及内翻试验结果,统计各组术后随访期间并发症发生情况。结果:所有患者均顺利完成手术。关节镜组切口总长度及恢复正常行走时间均显著少于切开组(P<0.05),两组手术时间及住院时间差异均无统计学意义(P>0.05)。术后CT显示,关节镜组1例距骨骨道位置欠佳,切开组1例跟骨骨道及1例距骨骨道位置欠佳,余骨道位置均位于相应足印区内。所有患者均获24~33个月随访。两组术后随访的AOFAS、Karlsson评分及VAS评分均优于术前(P<0.05),抽屉试验、内翻试验均为阴性。术后3个月时,关节镜组AOFAS、Karlsson评分及VAS评分均优于切开组(P<0.05)。术后6个月时,关节镜组AOFAS评分及Karlsson评分均优于切开组(P<0.05)。术后1年及2年时,两组AOFAS、Karlsson评分及VAS评分差异均无统计学意义(P>0.05)。术中及随访过程中均未出现严重并发症。结论:全关节镜下重建ATFL及CFL与切开重建治疗CLAI疗效相当,但全关节镜下恢复更快。

Objective To compare the clinical outcomes of all-inside arthroscopic and open reconstruction of the anterior talofibular ligament(ATFL)and calcaneofibular ligament(CFL).Methods The clinical data of 51 patients with chronic lateral ankle instability(CLAI)and treated in our department between January 2017 and July 2021 were analyzed retrospectively.Among them,24 received arthroscopic ATFL and CFL reconstruction(arthroscopy group),while 27 underwent conventional surgery(open group).The perioperative data including surgical time,intraoperative complications,hospitalization duration and time to resume normal walking were compared between the two groups.Moreover,postoperative CT examination was performed to evaluate the position of the bone tunnel.Before as well as 3 months,6 months,1 year,and 2 years after the operation,both groups were evaluated using the American Orthopedic Foot and Ankle Society Score(AOFAS),Karlsson score,visual analogue scale(VAS),drawer test,and inversion test.Meanwhile,the occurrence of complications was also recorded and compared.Results Both groups underwent the surgery successfully.The total length of incision and time to resume normal walking in the arthroscopy group were significantly shorter than the open group(P<0.05),while there was no significant difference between them in surgical time and hospital stay(P>0.05).Postoperative CT showed that in the arthroscopy group,1 case had suboptimal talus bone tunnel position,while in the open group,1 had suboptimal calcaneus bone tunnel position and another suffered from suboptimal talus bone tunnel position,with the remaining bone tunnels located within the corresponding footprint area.All patients were followed up for 24 to 33 months.Significant improvement was observed in the average AOFAS score,Karlsson score,and VAS score in both groups after the operation(P<0.05),and both the drawer and inversion tests were of negative results.Three months postoperatively,the arthroscopic group had significantly better AOFAS,Karlsson and VAS score than the open group(P<0.05).Moreover,at 6 months postoperatively,the average AOFAS and Karlsson scores of the arthroscopy group were significantly superior to the open group(P<0.05).However,1year and 2 years postoperatively,no significant differences were found between the two group in the AOFAS,Karlsson and VAS score(P>0.05).Moreover,no serious complications occurred during surgery and follow-up in both groups.Conclusion The efficacy of arthroscopic reconstruction of ATFL and CFL is comparable to open reconstruction in treating CLAI,with the former therapy resulting in faster recovery.