切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 244 -248. doi: 10.3877/cma.j.issn.1674-134X.2020.02.021

所属专题: 文献

临床经验

关节镜联合韧带缝合治疗外踝不稳的短期疗效
张常贵1, 魏东平2, 曹晋1, 林杨景1, 张成昌1, 杨柳1, 段小军1,()   
  1. 1. 400038 重庆,陆军军医大学第一附属医院(西南医院)关节外科中心
    2. 321000 金华,中国人民解放军73132部队88分队
  • 收稿日期:2019-06-17 出版日期:2020-04-01
  • 通信作者: 段小军
  • 基金资助:
    西南医院临床新技术计划项目(SWH2016BZGFGJJ-02)

Short-term efficacy of arthroscopy combined with ligament suture for chronic lateral ankle instability

Changgui Zhang1, Dongping Wei2, Jin Cao1, Yangjing Lin1, Chengchang Zhang1, Liu Yang1, Xiaojun Duan1,()   

  1. 1. Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
    2. Unit 88, Troop 73132 of the Chinese People's Liberation Army, Jinhua 321000, China
  • Received:2019-06-17 Published:2020-04-01
  • Corresponding author: Xiaojun Duan
  • About author:
    Corresponding author: Duan Xiaojun, Email:
引用本文:

张常贵, 魏东平, 曹晋, 林杨景, 张成昌, 杨柳, 段小军. 关节镜联合韧带缝合治疗外踝不稳的短期疗效[J/OL]. 中华关节外科杂志(电子版), 2020, 14(02): 244-248.

Changgui Zhang, Dongping Wei, Jin Cao, Yangjing Lin, Chengchang Zhang, Liu Yang, Xiaojun Duan. Short-term efficacy of arthroscopy combined with ligament suture for chronic lateral ankle instability[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(02): 244-248.

目的

随访采用关节镜手术联合小切口辅助下缝合距腓前韧带缝合术式治疗的患者,分析此术式治疗慢性外踝不稳的近期疗效,为进一步推广应用提供依据。

方法

回顾性随访自2016年1月至2018年5月,选择保守治疗无效的踝关节机械性不稳患者,排除功能性不稳、足踝部畸形等其他病史的患者。共纳入了西南医院关节外科63例应用关节镜手术联合韧带缝合术治疗慢性外踝不稳的患者。记录围手术期并发症,采用配对t检验分析术前与术后1年以上末次随访的踝关节视觉模拟疼痛(VAS)评分、美国足踝骨科协会踝与后足(AOFAS)评分。

结果

患者末次随访较术前踝关节VAS评分、AOFAS评分明显改善,差异有统计学意义(t=17.8、20.8,两者均P<0.01)。关节镜手术探查发现:合并软组织撞击征47例,撕脱性骨折24例,前踝骨性撞击征11例,距骨软骨损伤8例,关节游离体8例,腓骨肌腱脱位1例。患者术后均无严重并发症。

结论

关节镜手术联合韧带缝合术治疗慢性外踝不稳,可以获得较理想的近期疗效。该联合方案,既可以应用关节镜微创术处理踝关节内合并损伤,又可以使用锚钉技术缝合距腓前韧带,具有操作相对简单,并发症低的优势。

Objective

To follow the short-term efficacy of arthroscopy combined with small incision-assisted anterior tibiofibular ligament (ATFL) suture for chronic lateral ankle instability (CLAI) to provide reference for its further application.

Methods

Retrospective analysis was performed in the patients with chronic lateral ankle instability from January 2016 to May 2018 who underwent arthroscopy combined with ligament suture. The patients with mechanical instability who failed conservative treatment were selected, and patients with other medical histories such as functional instability and malformation of foot and ankle were excluded. Sixty-three patients with chronic lateral malleolus instability treated by arthroscopic surgery combined with ligamentous suture were included. Perioperative complications were recorded, and paired t test was used to analyze ankle visual analog scale (VAS) score and American Orthopedic Foot and Ankle Society (AOFAS) score at the last follow-up before and after one year.

Results

The last follow-up showed significantly improved VAS and AOFAS scores compared with the preoperative ones, and the difference was statistically significant (t=17.8, 20.8, both P<0.01). Arthroscopic probe found 47 cases of soft tissue impingement, 24 case of avulsion fracture, 11 cases of anterior ankle impingement, eight cases of osteochondral lesions of the talus, two cases of joint loose bodies, and one case of peroneal tendon dislocation. There was no serious postoperative complication.

Conclusion

Arthroscopy combined with ligament suture for CLAI which utilizes the minimally invasive arthroscopic technique to treat the intra-ankle joint combined injury and the anchor technology to suture the ATFL, has an ideal short-term efficacy and the advantages of relatively simple operation and low complications.

图1 使用锚钉技术完成Brostr?m-Gould术式。图A 为外踝弧形小切口;图B 为探查ATFL残端组织及其张力;图C 为1.5 mm克氏针钻孔促进创面新鲜化;图D 为使用刮匙促进创面新鲜化;图E 为在ATFL足印迹中心建立隧道;图F 为植入带线锚钉;图G 为锚钉及其可吸收线缝合ATFL后,逐层缝合切口
表1 关节镜手术联合韧带缝合术治疗慢性外踝不稳[n=63,(±s)]
图2 右外踝慢性不稳伴前踝软组织撞击综合征影像学检查及治疗图片。图A 为右踝术前X线正位片,示外踝游离体;图B 为右踝术前踝关节三维CT重建证实游离体;图C 为右踝术前MRI,示ATFL连续性中断;图D 为关节镜探查提示右前踝软组织撞击表现;图E 为右踝炎性软组织清除后视野;图F 为术后第1天复查右踝X片提示外踝游离体清除;图G 为术后1年复查右踝MRI提示ATFL连续性恢复
[1]
Feger MA, Glaviano NR, Donovan L, et al. Current trends in the management of lateral ankle sprain in the United States[J]. Clin J Sport Med, 2017, 27(2): 145-152.
[2]
Larsen E. Static or dynamic repair of chronic lateral ankle instability. A prospective randomized study [J]. Clin Orthop Relat Res, 1990,257: 184-192.
[3]
马骁,胡跃林.手术治疗慢性踝关节外侧不稳106例[J/CD].中华关节外科杂志(电子版),2011,5(1): 15-19.
[4]
Guillo S, Bauer T, Lee JW, et al. Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy[J]. Orthop Traumatol Surg Res, 2013, 99(8): S411-S419.
[5]
Keir AR, Christopher DM, Niall AS, et al. Current concepts review: arthroscopic treatment of anterior ankle impingement[J]. Foot Ankle Surg, 2017, 23(1): 1-8.
[6]
Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline[J/OL]. Br J Sports Med, 2018, 52(15): 956. doi: 10.1136/bjsports-2017-098106.
[7]
Kerkhoffs GM, Van Den Bekerom M, Elders LA, et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline[J]. Br J Sports Med, 2012, 46(12): 854-860.
[8]
Karlsson J, Lundin O, Lind K, et al. Early mobilization versus immobilization after ankle ligament stabilization[J]. Scand J Med Sci Sports, 2007, 9(5): 299-303.
[9]
Thompson C, Schabrun S, Romero RA, et al. Factors contributing to chronic ankle instability: a systematic review and meta-analysis of systematic reviews[J]. Sports Med, 2018, 48(1): 189-205.
[10]
Okuda R, Kinoshita M, Morikawa J, et al. Arthroscopic findings in chronic lateral ankle instability: do focal chondral lesions influence the results of ligament reconstruction?[J]. Am J Sports Med, 2005, 33(1): 35-42.
[11]
Brady TE, Frances AT, Emily N, et al. Intra-articular findings during the modified Brostrom procedure for lateral instability of the pediatric ankle[J]. J Pediatr Orthop B, 2018, 27(1): 73-76.
[12]
Michels F, Pereira H, Calder J, et al. Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(7): 2095-2102.
[13]
Song YJ, Hua YH. Similar outcomes at early term after arthroscopic or open repair of chronic ankle instability: a systematic review and meta-analysis[J]. J Foot Ankle Surg, 2019, 58(2): 312-319.
[14]
Matsui K, Burgesson B, Takao M, et al. Minimally invasive surgical treatment for chronic ankle instability: a systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1040-1048.
[15]
Wei S, Liu S, Han F, et al. Clinical outcomes of a modified all-inside arthroscopic repair of anterior talofibular ligament for chronic ankle instability: a preliminary report[J/OL]. Medicine, 2019, 98(36): e16734. doi: 10.1097/MD.0000000000016734.
[1] 纪小孟, 刘璠, 唐晓波, 卞为伟, 董佩龙, 刘振鲁. 两种手术方式治疗肩袖撕裂合并粘连性肩关节囊炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 561-567.
[2] 苏介茂, 齐岩松, 王永祥, 魏宝刚, 马秉贤, 张鹏飞, 魏兴华, 徐永胜. 关节镜手术在早中期膝骨关节炎治疗的应用进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 646-652.
[3] 郭艳波, 马亮, 李刚, 阎伟, 骆帝, 岳亮, 吴伟山. 全膝关节置换术后胫股关节脱位的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 658-671.
[4] 梁晓宗, 江吉勇, 李曼丹, 林海彬, 王昌义. 阔筋膜游离股前外侧穿支皮瓣修复足踝组织缺损[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 672-675.
[5] 杨占宇, 黄艳华, 马小迪, 冯安莹, 王旼娴, 龙青燕. 本体感觉训练对踝关节周围骨折患者步行能力的改善[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 477-483.
[6] 高小康, 张净宇, 刘金伟, 田东牧, 胡永成, 徐卫国. 连接型人工膝关节假体运动和负重模式的演变和进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 505-516.
[7] 于威, 王艺凯, 杨文博, 孟春庆, 王洪, 黄玮. 陈旧性前交叉韧带胫骨止点撕脱骨折的诊疗进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 532-537.
[8] 王典, 刘双赫, 曾峥. 肩关节镜术后肌肉功能改变对颈椎形态及矢状面参数影响的自身前后对照队列研究[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 371-378.
[9] 贾杰, 王阳, 车凯薇, 高俊峰, 王聪, 李泽阳, 梁虎. 梭形针线扣技术与Krackow缝合法对跟腱止点或近止点断裂跟腱功能恢复的疗效比较[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(04): 307-313.
[10] 杨城, 李祖儿, 刘青, 赵渊, 徐崇燕, 苏军, 张文云. 新型三维复合骨修复支架的制备工艺及其生物学性能[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 219-229.
[11] 郑燕生, 吴舒婷. 保留子宫圆韧带及补片完整的经腹腹膜前疝修补术的早期经验[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 428-432.
[12] 田淞宇, 张明月, 张宇博. 圆韧带悬吊联合腹腔镜子宫全切术对患者术后阴道膨出的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 433-436.
[13] 曲洋, 蒋浩然, 邢博涵, 张蒙, 张培训. 肩袖损伤的治疗进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 289-291.
[14] 高广涵, 张耀南, 石磊, 王林, 王飞, 郑子天, 王鸿禹, 郭民政, 薛庆云. 膝骨关节炎患者前交叉韧带功能影像学影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 301-307.
[15] 于晓光, 秦永辉, 李佳, 贾国兴, 李军, 赵振栓, 刘国彬. 人工单髁置换术治疗膝关节内侧间室骨关节炎合并前交叉韧带功能不良的近期疗效[J/OL]. 中华临床医师杂志(电子版), 2024, 18(04): 337-342.
阅读次数
全文


摘要