摘要
[目的]探讨经皮功能重建踝关节外侧韧带复合体治疗慢性踝关节不稳的临床疗效。[方法]2014年1月~2018年2月,符合纳入标准的47例慢性踝关节不稳患者随机分为两组,其中,切开组23例采用常规切开术式重建距腓前韧带(ATFL)和跟腓韧带(CFL),经皮组24例采用超声定位,经皮建立骨隧道重建ATFL和CFL。比较两组间手术时间、围术期并发症、踝背伸-跖屈活动度(ROM)、AOFAS评分、VAS评分,应力位影像测量距骨前移度和倾斜度。[结果]术中切开组2例出现腓浅神经损伤。经皮组手术时间、切口总长度显著小于切开组,差异有统计学意义(P<0.001)。切开组术后4例切口边缘处坏死,而经皮组1例切口渗液。两组患者随访26~30个月,平均(27.39±2.51)个月。术后6个月时,经皮组ROM显著大于切开组(P<0.05)。随时间推移两组患者AOFAS评分均显著增加,而VAS评分显著减少(P<0.001),但是两组相同时间点AOFAS评分和VAS评分的差异均无统计学意义(P>0.05)。应力位X线测量方面,术后两组患者距骨前移距度和距骨倾斜角均较术前显著减少(P<0.001)。但是两组相同时间点在距骨前移距度和距骨倾斜角的差异均无统计学意义(P>0.05)。[结论]经皮踝关节外侧韧带复合体重建治疗慢性踝关节不稳的效果与常规开放手术相当,但具有手术时间短、创伤小、并发症少的优点。
[Objective]To explore the clinical outcomes of percutaneous reconstruction of ankle lateral ligament complex for chronic ankle lateral instability.[Methods]From January 2014 to February 2018,47 patients who suffered from chronic ankle lateral instability and met the inclusion criteria of this study were randomly divided into 2 groups.Of them,23 patients in the open group had anterior talofibular ligament(ATFL)and calcaneofibular ligament(CFL)reconstructed through conventional open incision,while the remaining 24 patients in the percutaneous group received ATFL and CFL reconstruction by percutaneous technique after ultrasound location.The operation time,perioperative complications,ankle dorsal flexion to plantar flexion range of motion(ROM),AOFAS and VAS scores,as well as anterior talus displacement and talus tilt measured on radiographs under stress were compared between the two groups.[Results]During operation,superficial sural never injury happened in two patients of the open group,whereas fibular tunnel fracture occurred in 2 patients of the percutaneous group,which was resolved by enlarging incision and fixation with 2 anchors.The percutaneous group proved significantly superior to the open group regarding operation time and total incision length(P<0.05).After operation,the open group was noticed skin edge necrosis in 4 patients,whereas the percutaneous group got primary incision healing in all patients.The follow-up period lasted for 26~30 months with an average of(27.39±2.51)months.The percutaneous group regained greater ROM at 6 months postoperatively than the open group(P<0.05).The AOFAS scores significantly increased,whereas the VAS scores significantly decreased in both groups over time(P<0.05),although no a statistically significant difference in these scores was found in any matching time point between the two groups(P>0.05).With respect to radiographic measurement under stress,both the anterior talus displacement and talus tilt significantly decreased in the two groups postoperatively compared with those before operation(P<0.05),nevertheless no statistically significant differences were proved at any corresponding time point between the two groups(P>0.05).[Conclusion]This percutaneous reconstruction of ankle lateral ligament complex does achieve comparable clinical outcomes to the convention open technique for chronic ankle lateral instability,and has advantages of shortening operation time,reducing iatrogenic trauma and complications.
作者
崔银江
付新生
郝晓东
姜波
张峰
CUI Yin-ji⁃ang;FU Xin-sheng;HAO Xiao-dong;JIANG Bo;ZHANG Feng(Central Hospital of Xinxiang City,Xinxiang 453000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第10期876-881,共6页
Orthopedic Journal of China
关键词
慢性踝关节外侧不稳
距腓前韧带
跟腓韧带
经皮重建术
chronic ankle lateral instability
anterior talofibular ligament
calcaneofibular ligament
percutaneous reconstruction
