关节镜下韧带增强固定与改良Brostrom术治疗慢性踝关节外侧不稳定的效果比较

目的探讨慢性踝关节外侧不稳定病人分别采用改良Brostrom术和关节镜下韧带增强固定术后的治疗效果。方法 2016年1月~2018年8月我院诊断为慢性踝关节外侧不稳定且行手术治疗的病人56例,采用随机数字表法将56例病人分为改良Brostrom术组和关节镜组,每组各28例。改良Brostrom术组病人采用改良Brostrom术治疗,关节镜组病人采用关节镜下利用锚钉和缝合带对韧带进行增强固定治疗。两组病人治疗后均随访1年,比较两组病人手术时间、术中出血量、术后下地活动时间、切口愈合情况及踝关节不稳定发生情况;并在术后6个月及术后1年予以FOAS评分系统、FAAM评分系统、距骨倾斜角和距骨前移距离评估两组病人踝关节功能状态以及踝关节外侧不稳定复发情况。结果关节镜组的手术时间为(50.91.±8.07)分钟、术后下地活动时间为(4.67±1.36)天,改良Brostrom术组的手术时间(56.76±7.93)分钟、术后下地活动时间(6.35±2.04)天,关节镜组出血量(37.05±8.17)ml,改良Brostrom术组(42.43±6.98)ml,两组比较差异具有统计学意义(P<0.05)。术后6个月及术后1年时关节镜组疼痛评分(54.23±5.28)分和(44.63±4.45)分、症状评分分别为(52.53±6.34)分和(47.81±5.22),改良Brostrom术组分别为(66.12±5.29)和(62.19±4.77)分、(62.25±6.23)分和(52.88±4.67)分,两组比较差异均有统计学意义(P<0.05)。两组术后6个月及术后1年时生活能力、运动能力、生活质量、日常活动、活动能力、总分比较差异均有统计学意义(P<0.05)。关节镜组术后1年距骨倾斜角为(4.43±1.03)°,距骨前移距离(4.65±1.41)mm,改良Brostrom术组分别为(5.73±1.45)°和(5.68±1.69)mm,两组比较差异有统计学意义(P<0.05)。随访过程中两组病人切口愈合情况无明显差异。改良Brostrom术组踝关节不稳定发生率(14.28%)高于关节镜组,差异有统计学意义(P<0.05)。结论对于慢性踝关节外侧不稳定的病人,关节镜下韧带增强固定与改良Brostrom术相比,能在减小手术创伤的同时能更好的提高踝关节运动能力,获得更好的踝关节稳定性,病人可尽早下地活动。

Comparison of arthroscopic ligament enhancement and modified Brostrom in the treatment of chronic ankle instability

Objective To explore the therapeutic effect of patients with chronic lateral lateral ankle instability after modified Brostrom surgery and arthroscopic ligament enhancement.Methods Fifty-six patients with chronic lateral lateral ankle instability and surgical treatment were enrolled in our hospital from January 2016 to August 2018.They were divided into modified Brostrom group and arthroscopy group according to random number table,28 cases in each group.Patients in the modified Brostrom group were treated with modified Brostrom,and the arthroscopy group underwent arthroscopic fixation of the ligament with anchors and sutures.After treatment,the two groups of patients were followed up for 1 year.The operation time,intraoperative blood loss,postoperative activity time,wound healing and ankle instability were compared between the two groups.The FOAS scoring system,FAAM scoring system,talar inclination angle,and talar advance distance were evaluated at 6 months and one year after surgery to evaluate the ankle joint function status and the recurrence of lateral ankle instability.Result The arthroscopic operation time(50.91±8.07)min and postoperative ground movement time(4.67±1.36)d were shorter than the modified Brostrom operation group(56.76±7.93)min and postoperative ground movement time(6.35±2.04)d.The bleeding volume in the arthroscopy group(37.05±8.17)ml was less than that in the modified Brostrom operation group(42.43±6.98)ml,P<0.05.The pain score(54.23±5.28/44.63±4.45)and symptoms(52.53±6.34/47.81±5.22)of the arthroscopic group at 6 months and 1 year after surgery were significantly lower than the pain score(66.12±5.29/62.19)and symptoms(62.25±6.23/52.88±4.67)of the modified Brostrom group(P<0.05).The differences in living ability,sports ability,quality of life,daily activities,activity ability and total scores were statistically significant 6 months and 1 year after surgery(P<0.05).The talar tilt angle(4.43±1.03)° and talar advance distance [(4.65±1.41)mm] in the arthroscopic group after 1 year were lower than those of the modified Brostrom operation group [(5.73±1.45)°/(5.68±1.69)mm,P<0.05].There was no significant difference in wound healing between the two groups during follow-up,but the incidence of ankle instability(14.28%)in the modified Brostrom group was higher than that in the arthroscopy group(P<0.05).Conlusion For the treatment of patients with chronic lateral ankle instability,arthroscopic ligament augmentation and fixation can not only reduce surgical trauma,but also improve ankle motion capacity and obtain better ankle stability compared with modified Brostrom,and help patients to go to the ground as early as possible.