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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 636 -639. doi: 10.3877/cma.j.issn.1674-134X.2020.05.021

所属专题： 文献；

临床经验

踝关节镜下修复距腓前韧带治疗慢性踝关节不稳
徐柯烽1, 林平1,†(), 涂迎春1, 李焘1, 赵驰1, 马犇1   
  1. 1. 321000　金华，浙江大学附属金华医院(金华市中心医院)
  • 收稿日期:2019-06-14 出版日期:2020-10-01
  • 通信作者: 林平
  • 基金资助:
    金华市科学技术研究计划项目(2019-3-009)

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

Kefeng Xu1, Ping Lin1,†(), Yingchun Tu1, Tao Li1, Chi Zhao1, Ben Ma1   

  1. 1. Department of Orthopaedics, Jinhua Municipal Central Hospital, Jinhua 321000, China
  • Received:2019-06-14 Published:2020-10-01
  • Corresponding author: Ping Lin
  • About author:
    Corresponding author: Lin Ping, Email:
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引用本文：

徐柯烽, 林平, 涂迎春, 李焘, 赵驰, 马犇. 踝关节镜下修复距腓前韧带治疗慢性踝关节不稳[J]. 中华关节外科杂志(电子版), 2020, 14(05): 636-639.

Kefeng Xu, Ping Lin, Yingchun Tu, Tao Li, Chi Zhao, Ben Ma. Treatment of chronic ankle instability by repairing anterior talofibular ligament with arthroscope[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(05): 636-639.

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。

关键词: 踝关节, 关节镜, 侧副韧带, 关节不稳定性
Objective

To investigatethe clinical efficacy of the modified Brostrom methodunder ankle arthroscope to repair the anterior tibiofibular ligament (ATFL) for chronic ankle instability.

Methods

From 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.

Results

All 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).

Conclusion

Anatomical 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.

Key words: Ankle joint, Arthroscopes, Collateral ligaments, Joint instability
图1 改良Brostr?m法解剖修复ATFL(距腓前韧带)手术步骤。图A清理腓骨远端前方表面周围组织，暴露腓骨远端；图B探钩探查见ATFL松弛；图C于ATFL下方套入缝线并进行套圈；图D拉紧缝线使ATFL保持一定张力；图E植入挤压钉1枚固定缝线；图F剪断缝线线尾，镜下见韧带张力良好
图2 改良Brostr?m法解剖修复ATFL(距腓前韧带)手术示意图。缝线套扎ATFL，拉紧韧带至合适张力后，1枚空心钉挤压固定缝线于腓骨尖近端，右图为左图的局部放大
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