关节镜下外侧韧带增强修补术对慢性踝关节不稳定的疗效分析

Analysis of the effect of arthroscopic enhanced repair of lateral ligament on chronic lateral ankle instability

目的 评价关节镜下距腓前韧带(anterior talofibular ligament, ATFL)缝线增强修补术对慢性踝关节不稳定(chronic lateral ankle instability, CLAI)的临床疗效。方法 对2019年6月至2021年9月期间在南京医科大学附属南京医院治疗的105例慢性踝关节不稳定患者进行回顾性分析。其中,男60例,女45例,平均年龄为31.17岁,均采用关节镜下ATFL缝线增强修补术。通过术前、术后的疼痛视觉模拟评分(visual analogue scale, VAS)、美国骨科足踝协会踝与后足评分(American Orthopaedic Foot and Ankle Society, AOFAS)评分、前抽屉试验和影像学评估来评价临床疗效。结果 105例患者均顺利完成了关节镜下距腓前韧带缝线增强修补术,且均未出现严重并发症。随访12~30个月,平均随访(23.26±1.16)个月中,所有患者均未出现踝关节不稳定复发。患者AOFAS评分由术前(62.17±5.56)分升至术后(93.47±4.06)分、VAS评分由术前(4.17±1.02)分下降至术后(1.06±0.36)分,较术前均有改善,差异有统计学意义(P<0.05)。患者术后踝关节跖屈-内翻角度、踝关节内翻应力(talar tilt value, TT)值和踝关节前抽屉应力(anterior drawer value, AD)值较术前均明显改善,差异有统计学意义(P<0.05)。结论 关节镜下距腓前韧带缝线增强修补术治疗慢性踝关节不稳定取得了令人满意的临床疗效,且无严重不良反应,具有安全性高、可靠性强的优点,推荐临床使用。

Objective To assess the clinical effectiveness of arthroscopic repair enhanced with suture of the anterior talofibular ligament(ATFL)for chronic lateral ankle instability.Methods All 105 patients with chronic lateral ankle instability treated at Nanjing First Hospital,Nanjing Medical University between June 2019 and September 2021 were retrospectively analyzed.Patients included 60 males and 45 females,with a mean age of 31.17 years,all of whom were treated with arthroscopic ATFL suture augmentation repair.Clinical efficacy of CLAI was evaluated by visual analogue scale(VAS),American Orthopaedic Foot and Ankle Society(AOFAS)score,anterior drawer test and imaging evaluation before and after operation.Results All 105 patients successfully completed arthroscopic enhanced suture repair of the anterior talofibular ligament without serious complications.During the follow-up 12-30 months[mean(23.26±1.16)months],there was no recurrence of ankle instability in any of the patients.The AOFAS score increased from(62.17±5.56)to(93.47±4.06),and the VAS score decreased from(4.17±1.02)to(1.06±0.36),which was significantly better than that before operation(P<0.05).The ankle metatarsal flexion-varus angle,talar tilt value(TT)and ankle anterior drawer value(AD)were significantly improved after operation(P<0.05).Conclusion Arthroscopic repair with enhanced suture of the anterior talofibular ligament for chronic ankle instability achieved satisfactory clinical efficacy without serious adverse effects,with the advantages of high safety and reliability,and is recommended for clinical use.