关节镜下Lasso-loop Gould术式治疗踝关节外侧不稳定的早期疗效

doi:10.3877/cma.j.issn.1674-134X.2024.02.018

目的

探讨全关节镜下Lasso-loop Gould术式修复距腓前韧带(ATFL)治疗踝关节外侧不稳定的早期疗效。

方法

本研究采用前瞻性病例分析晋江市医院2022年1月至2023年1月采用全关节镜下Lasso-loop Gould术式修复距腓前韧带ATFL治疗踝关节外侧不稳定患者。采用美国足踝外科协会踝－后足功能(AOFAS)评分、视觉模拟评分(VAS)对手术前后疗效及疼痛进行评价，采用配对样本Wilcoxon带符号秩检验进行统计学分析。

结果

共纳入25例患者(男13例、女12例)，年龄为31(19，40)岁，受伤至手术时间为9(7，18)个月；获得6(3，10)个月随访。AOFAS评分由术前59.0(48.0，66.0)分提高至末次随访时98.0(85.0，100.0)分，差异具有统计学意义(Z＝4.38，P<0.001)；VAS评分由术前为4.0(3.0，5.0)分降低至末次随访时1.0(0，2.5)分，差异具有统计学意义(Z＝4.33，P<0.001)，术后优19例，良2例，可4例。

结论

全关节镜下Lasso-loop Gould术式修复ATFL治疗踝关节外侧不稳定可以恢复踝关节的稳定性，同时处理关节内损伤，早期疗效良好。

关键词: 踝关节, 关节不稳定性, 关节镜, 外侧韧带，踝

Objective

Explore the early efficacy analysis of the Lasso-loop Gould procedure under total arthroscopy for repairing the ATFL in the treatment of lateral ankle instability.

Methods

A prospective case study analysis was performed on the patients with lateral instability of the ankle joint who underwent arthroscopic surgery in Jinjiang Hospital From January 2022 to January 2023, were treated with a total arthroscopic Lasso-loop Gould procedure to repair the ATFL. The efficacy and pain before and after surgery were evaluated using AOFAS and VAS scores by Wilcoxon rank sum test.

Results

A total of 25 patients, including 13 males and 12 females, were enrolled, with age of 31(19, 40)years, and the time from injury to surgery was 9(7, 18)months. All the patients were followed up for 6(3, 10)months. The AOFAS score increased from 59.0(48.0, 66.0)before surgery, to 98.0(85.0, 100.0)at the last follow-up, with a statistically significant difference (Z=4.38, P<0.001). The VAS score increased from 4.0(3.0, 5.0)before surgery, to 1.0(0, 2.5) at the last follow-up , with a statistically significant difference (Z=4.33, P<0.001). There were 19 postoperative excellent cases, two good cases, and four fair cases.

Conclusion

Under total arthroscope, the Lasso-loop Gould procedure for repairing the ATFL can restore the stability of the ankle joint in the treatment of lateral instability, it can also handle intra-articular injuries and achieve good therapeutic effects at early stage.

Key words: Ankle, Joint instability, Arthroscope, Lateral ligament, ankle

图3 ATFL(距腓前韧带)撕裂患者行Lasso-loop Gould术式修补术后末次随访。图A为术前踝关节MRI，示ATFL腓骨止点撕脱；图B示术后3个月踝关节MRI，示ATFL修补后局部瘢痕组织填充，张力适中；图C示患者术后3个月功能良好

Figure 3 Last follow-up of the patient with ATFL tear undergoing Lasso-loop-Gould repair. A is MRI of ankle joint before operation, showing ATFL fibular avulsion at the insertion point; B is MRI of ankle joint at three months after operation, showing that the local scar tissue filled with moderate tension after ATFL repair; C shows that the patient′s function is good three months after surgery

图1 踝关节镜下操作示意图。图A可见ATFL(距腓前韧带)腓骨止点撕裂、体部撕裂；图B可见铆钉置入与腓骨长轴成45°、距腓骨尖约1 cm;图C可见缝合钩穿刺韧带残端利用0#PDS(聚对二氧环己酮可吸收线)过线；图D为牵拉锚钉第1根线的另一头，可见韧带残端被提拉收紧；图E示暂不收紧锚钉第1根线的另一头；图F为腰穿针从皮肤标记点进针；图G示踝关节背伸90°中立位将第1根锚钉线未套扎的一头提拉收紧打结；图H示线①的一端穿过ATFL断端过线，然后线①同一端进行套扎，形成环(loop)，再将线①另一端收紧、打结，使ATFL复位，最后线②行Gloud修补加强

Figure 1 Schematic diagram of ankle arthroscopic operation. A shows ATFL fibular insertion point tear and body tear; B shows the rivet is inserted at a 45°angle to the long axis of the fibula, approximately one centimeter away from the tip of the fibula; C shows the suture hook is used to puncture the residual end of the ligament through the 0 # PDS thread; D shows when the other end of the first thread of anchor nail is pulled, the residual end of the ligament can be tightened; E shows that the other end of the first line of the anchor nail is not tightened temporarily; F shows lumbar puncture needle inserting at the marker point on the skin; G shows that at 90°dorsal extension of the ankle joint in a neutral position, the end of the first anchor thread which has not been ligated is pulled and tied tightly; H shows that one end of thread ① passes through the broken end of ATFL, and this end of thread ① is tied to form a loop, then the other end of thread ① is tightened and knotted to reset ATFL, while thread ② is used for Gloud repaire and strengthen

图2 左踝关节镜探查发现。图A示腓骨尖陈旧性撕脱骨折；图B示内踝游离体；图C示前内侧骨性撞击

Figure 2 The findings of left ankle arthroscopy. A shows an old avulsion fracture of the fibular apex; B shows free body in the medial ankle; C shows the anterior medial bony impact

表1 术前与末次随访AOFAS评分及VAS评分[M(P₂₅，P₇₅)]

Table 1 AOFAS and VAS scores before surgery and at the last follow-up

测量时间Time point	VAS评分	AOFAS评分
术前Before surgery	4.0(3.0，5.0)	59.0(48.0，66.0)
末次随访Last follow-up	1.0(0，2.5)	98.0(85.0，100.0)
Z值	4.33	4.38
P值	<0.001	<0.001

表1 术前与末次随访AOFAS评分及VAS评分[M(P₂₅，P₇₅)]

Table 1 AOFAS and VAS scores before surgery and at the last follow-up

测量时间Time point	VAS评分	AOFAS评分
术前Before surgery	4.0(3.0，5.0)	59.0(48.0，66.0)
末次随访Last follow-up	1.0(0，2.5)	98.0(85.0，100.0)
Z值	4.33	4.38
P值	<0.001	<0.001

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Early efficacy of Lasso-loop Gould procedure under arthroscope for treatment of lateral ankle instability

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Early efficacy of Lasso-loop Gould procedure under arthroscope for treatment of lateral ankle instability