踝关节镜下修复距腓前韧带治疗慢性踝关节不稳

目的探讨踝关节镜下改良Brostr?m法解剖修复距腓前韧带(ATFL)治疗慢性踝关节不稳的临床疗效。 方法选取2015年12月至2017年1月慢性踝关节不稳患者共12例，均采用踝关节镜辅助下改良Brostr?m法解剖修复距腓前韧带进行治疗。采用美国足踝外科学会(AOFAS)评分标准、Tegner运动水平评分及距骨倾斜角变化对手术前后疗效进行评价，随访观察并发症发生情况。治疗前后各观察指标比较采用配对t检验。 结果12例均获得15～46个月随访，平均(26±8)个月。随访期间，所有患者踝关节活动度基本达到正常水平，未出现踝关节不稳，无踝关节肿胀、疼痛等表现，末次随访AOFAS评分为(91.0±2.6)分、Tegner评分为(6.0±1.2)分，两者较术前均明显提高(t ＝10.57、12.38，均为P<0.001)。距骨倾斜角(4.5±1.0)°较术前降低(t＝7.13，P<0.001)。 结论踝关节镜下改良Brostr?m法解剖重建ATFL治疗慢性踝关节不稳，能更精准地探查韧带断端、定位韧带附着点、创伤小、疼痛轻、术后恢复快，疗效理想。

Treatment of chronic ankle instability by repairing anterior talofibular ligament with arthroscope

ObjectiveTo investigatethe clinical efficacy of the modified Brostrom methodunder ankle arthroscope to repair the anterior tibiofibular ligament (ATFL) for chronic ankle instability. MethodsFrom December 2015 to January 2017, 12 patients with chronic ankle instability were treated by modified Brostrom method under ankle arthroscope for repairing anterior talofibular ligament(ATFL). The American Foot and Ankle Surgery Society score (AOFAS), Tegner exercise level score and talus tilt angle change were used to evaluate the curative effect before and after operation, and the patients were followed up to observe the occurrence of complications. Paired t test was used to compare the observation indexes before and after treatment. ResultsAll the 12 patients were followed up for (26±8) months on average. During the follow-up period, ankle activity was basically restored to normal in all of them, and ankle instability was not occurred. Ankle swelling and pain disappeared. At the last follow-up, the AOFAS score was (91.0±2.6) and the Tegner score was (6.0±1.2), which were significantly higher than the preoperative ones(t =10.57, 12.38, both P<0.001). The talus inclination angle was (4.5±1.0)° which was lower than the preoperative one(t=7.13, P<0.001). ConclusionAnatomical reconstruction ATFL under ankle arthroscope could more accurately detect ligament breaks, locate ligament attachment points, with less trauma, mild pain, and quick recovery in the treatment of chronic ankle instability.