全关节镜下改良Broström术治疗慢性踝关节外侧不稳的临床疗效观察

目的 探讨全关节镜下改良Broström术治疗慢性踝关节外侧不稳的临床疗效。方法 回顾性研究。纳入2016年1月—2018年6月徐州市中心医院慢性踝关节外侧不稳患者33例(33侧),其中男20例、女13例,年龄16～55(30.3±5.7)岁;右侧22例,左侧11例。病程12~48(25.6±14.2)个月。受伤原因:扭伤28例,车祸伤5例。所有患者进行全关节镜下的改良Broström手术。术后定期随访,观察患者伤口愈合情况,并发症发生情况,观察踝关节活动情况,踝关节内翻应力试验、踝关节前抽屉试验检查踝关节稳定情况及步态。术后12个月采用疼痛视觉模拟评分法(VAS)评价踝关节疼痛情况,采用美国足踝外科协会(AOFAS)踝与后足评分和Karlsson 踝关节功能评分(KAFS)评价踝关节功能。对比患者手术前与术后12个月VAS、AOFAS、KAFS评分改善情况。结果 33例患者均顺利完成手术,手术时间35～80(50.3±12.6)min。术后患者切口均一期愈合,未出现伤口感染、神经损伤、血管损伤、肌腱损伤等并发症。33例患者均获得随访,随访时间12～40(25.0±10.7)个月。末次随访时,患者均无置入物排斥反应或线结反应;踝关节疼痛完全消失,关节活动度良好;踝关节内翻应力试验、踝关节前抽屉试验均阴性,未出现踝关节外侧不稳定,患者均恢复正常步态。术后12个月依据AOFAS评分标准,踝关节功能优27例、良6例;依据KAFS评分标准,踝关节功能优28例、良5例。术后12个月VAS评分由术前(6.02±1.93)分降低到(1.33±0.16)分,AOFAS评分由术前(61.75±13.08)分提高到(92.37±4.15)分,KAFS评分由术前(64.46±10.81)分提高到(93.19±5.58)分,差异均有统计学意义(t=12.765, -13.303, -12.346, P值均＜0.05)。结论 全关节镜下改良Broström术,手术创伤小,是一种治疗慢性踝关节外侧不稳的有效方法。

Clinical effcacy of all-inside arthroscopic modified Broström procedure for the treatment of chronic lateral ankle instability

Objective To investigate clinical effcacy of all-inside arthroscopic modified Broström procedure for the treatment of chronic lateral ankle instability.Methods This retrospective study collected the data of 33 patients (20 males, 13 females; 16-55 years, [30.31±5.70] years on average) in Xuzhou Central Hospital from January 2016 to June 2018. A total of 22 cases involved chronic lateral ankle instability on the right side, and 11 cases had the same condition on the left side. The course of disease ranged from 12 to 48(25.6±14.2) months. Twenty-eight cases had sprain injury, and the rest had this condition due to traffic/vehicular accident. All patients were treated with all-inside arthroscopic modified Broström procedure. Incision healing, complications, visual analogue pain scale (VAS), and ankle activity were observed. Ankle varus stress test and anterior drawer test were performed to evaluate ankle stability and gait. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale and Karlsson Ankle Functional Score (KAFS) were used to assess ankle functions. At 12 months after the surgery, postoperative ankle functional outcomes, including VAS, AOFAS, and KAFS, were compared with the preoperative data.Results The surgery in all cases went smoothly. Operation time was 35-80(50.3±12.6)min. All incisions healed by first intention, without evidence of postoperative complications of implant rejection, ligation reaction, and nerve, vessel, and tendon injury. The follow-up period ranged from 12 months to 40 months (25.0±10.7 months on average). At the final follow up, normal ankle functions and normal walking gait were regained in all cases without ankle pain and walking pain. Ankle varus stress test and anterior drawer test were negative. No evidence supporting lateral ankle instability was obtained. All patients eventually regained normal gait. Twelve months after surgery, the ankle function was evaluated according to AOFAS scoring standard, and 27 cases were excellent and 6 cases were good. According to KAFS, 28 cases were excellent and 5 cases were good. At 12 months after the surgery, mean postoperative VAS significantly decreased from (6.02±1.93) points to (1.33±0.16) points, AOFAS significantly improved from (61.75±13.08) points to (92.37±4.15) points, and KAFS significantly improved from (64.46±10.81) points to (93.19±5.58) points (t=12.765, -13.303, -12.346, respectively; all P values＜0.05).Conclusions All-inside arthroscopic modified Broström procedure, with minimally invasive, is an effective procedure for the treatment of chronic lateral ankle instability.