全踝关节镜下改良brostrom手术治疗踝关节慢性不稳定

目的探讨分析全踝关节镜下改良brostrom手术治疗踝关节慢性不稳定的临床效果。方法将2013年8月~2015年8月我院收治的82例踝关节慢性不稳定患者纳入课题分析中,治疗方式为全踝关节镜下改良brostrom手术,比较不同时间点踝关节慢性不稳定患者踝关节查体结果、AOFAS评分、疼痛视觉模拟评分(VAS)及并发症发生情况。结果患者术后踝关节距骨倾斜角、距骨前移距离、踝关节跖屈角度、踝关节背伸角度、踝关节内翻角度、踝关节外翻角度较手术前有显著的好转(P0.001);Davis-Weber A、B、C型患者术后疼痛、异常步态、踝部支撑与自主功能、踝关节屈伸情况、最大步行距离和踝关节的稳定性踝关节功能的改善情况以及AOFAS评分较术前显著改善(P0.001);Davis-Weber A、B、C型术后患者距骨倾斜角、距骨前移距离、踝关节跖屈角度、踝关节背伸角度、踝关节内翻角度、踝关节外翻角度较术前有了显著的好转(P0.001)。术后随访两年,患者踝关节查体结果与术后相比,能够得到较为良好的维持,各项查体结果与术后相比差异无统计学意义(P0.05)。患者术后及术后随访两年,均无显著的神经损伤、感染、皮缘坏死等术后并发症发生。结论对于踝关节慢性不稳定患者采取全踝关节镜下改良brostrom手术进行治疗后,患者踝关节查体情况良好,术后AOFAS评分及VAS评分显著降低,临床效果显著,预后患者疼痛、踝关节功能恢复等情况均得到了显著的改善。

The analysis of bostrom pocedure for treatment of chronic ankle instability

［Abstract］ Objective To analyze the effects of modified Brostrom procedure for treatment of chronic ankle instability. Methods Eighty-two patients in our department from August 2013 to August 2015 were selected. The patients underwent the modified Brostrom procedure for treating chronic ankle instability. The examination results of ankle， scores of AOFAS， scores of VAS， complications were recorded and analyzed. Results Postoperative ankle physical examination， such as talar tilt angle， talus forward shift， ankle plantar flexion， dorsiflexion， valgus， varus， showed that the clinical indicators after modified surgery were significantly better than those before surgery， and the differences between the two had statistical significance （all P values were less than 0.001）. In the patients with Davis-Weber type A， B， C， the postoperative pain， abnormal gait， ankle support and autonomic function， ankle flexion and extension， maximum walking distance， ankle stability， ankle joint function and AOFAS score were improved significantly compared with those before operation （all P values were less than 0.001）. And talar tilt angle， talus forward shift， ankle plantar flexion， dorsiflexion， valgus， varus were got improvement in these patients with Davis-Weber type A， B， C （all P values were less than 0.001）. After two years of follow-up， the results of ankle joint examination were better maintained than that after operation， and there was no significant difference between the results of various examinations and that after operation （P>0.05）. There were no significant postoperative complications such as nerve injury， infection and necrosis of the skin margin in the two-year follow-up of the patients （P>0.05）. No skin necrosis happened in all patients. Conclusion Brostrom procedure could improve examination results and function of ankle， reduce VAS scores and AOFAS scores， enhance clinical effect.