关节镜下行外侧韧带修复术治疗慢性踝关节外侧不稳症

目的探讨关节镜下带线锚钉缝合修复距腓前韧带治疗慢性踝关节外侧不稳症的临床疗效。方法2017年1月—2018年6月,对20例慢性踝关节外侧不稳症患者在保守治疗效果不佳后,行关节镜下带线锚钉缝合修复距腓前韧带,手术前后根据症状、体征、MRI和应力位片、AOFAS评分、Cumberland踝关节不稳定评分问卷对手术疗效进行评价。结果20例均获得12~18个月随访,平均(12.5±3.5)个月。术后1个月,所有患者踝关节不稳感完全消失,5例患者缝合区稍有压痛感,轻微肿胀,支具保护下正常行走,2例患者有局部皮肤麻木感。术后1年内,所有患者踝关节疼痛、不稳感、肿胀均消失,行走正常,关节活动度良好,前抽屉试验(-),内翻试验(-),1例患者局部皮肤仍有麻木感,1例明显好转,末次随访时AOFAS评分为(92.0±5.6)分,较术前明显提高,差异有统计学意义(P<0.001)。术前Cumberland评分13分,术后30分。结论关节镜下带线锚钉加强缝合修复距腓前韧带治疗慢性踝关节外侧不稳症可以更好地恢复踝关节的稳定性,手术创伤较小,操作简便,术后并发症少,并且能取得良好疗效。

Arthroscopic repair of lateral ligament for chronic lateral instability of ankle

Objective To investigate the clinical effect of arthroscopic suture with anchor to repair the anterior talofibular ligament in the treatment of chronic lateral ankle instability.Methods From January 2017 to June 2018,20 patients with chronic lateral instability of ankle were treated with arthroscopic suture and anchor to repair the anterior talofibular ligament.Before and after the operation,the effect of the operation was evaluated according to symptoms,physical signs,MRI,stress films,AOFAS scores.and Cumberland scores.Results 20 cases were followed up for 12~18 months,with an average of(12.5±3.5)months.One month after the operation,all patients’ankle instability disappeared completely.5 patients had slight tenderness and swelling in the suture area,walked normally under the protection of brace,and 2 patients had local skin numbness.Within one year after the operation,,all patients’ankle pain,instability and swelling disappeared,walked normally,joint mobility was good,front drawer test(-),varus test(-),local skin of one patient still had numbness,and one patient was significantly improved.AOFAS score was(92.0±5.6)at the last follow-up,which was significantly higher than that before the operation,the difference was statistically significant(P<0.001).The Cumberland score was 13 before operation and 30 after operation.Conclusion Arthroscopic repair of the anterior talofibular ligament with wire anchor can restore the stability of the ankle,with less trauma,simple operation,less postoperative complications and good results.