摘要
目的比较全踝关节镜下缝线增强修补术和肌腱重建术治疗前距腓韧带(ATFL)残端质量不佳的慢性踝关节不稳定的疗效。方法采用回顾性队列研究分析2018年1月至2020年8月复旦大学附属华山医院收治的37例慢性踝关节不稳定患者的临床资料,其中男34例(34踝),女3例(3踝);年龄18~57岁[(32.2±7.2)岁]。受伤至手术时间为3~360个月[48(12,120)个月]。均行全踝关节镜下踝关节稳定手术治疗,其中19例行缝线增强修补术(增强修补组),18例行传统自/异体肌腱重建术(肌腱重建组)。记录两组术中所见ATFL损伤程度和关节内病变(骨赘、游离体、软骨损伤)。比较两组术前、末次随访时Karlsson评分和Tegner评分,以及术后完成部分负重/恢复正常行走/重返运动例数及其所需时间。观察术后并发症情况。结果患者均获随访12~32个月[21(16,28)个月]。两组术中所见ATFL损伤程度和关节内病变(骨赘、游离体、软骨损伤)差异无统计学意义(P均>0.05)。末次随访时增强修补组与肌腱重建组Karlsson评分分别为95.0(90.0,98.5)分、95.0(87.8,99.3)分,较术前的65.0(51.0,75.0)分、65.0(53.3,78.0)分明显提高;Tegner评分分别为5.0(3.5,6.0)分、5.0(3.3,6.0)分,较术前的3.0(2.0,4.0)分、2.5(1.3,4.0)分明显提高(P均<0.01)。两组间Karlsson评分和Tegner评分差异无统计学意义(P均>0.05)。增强修补组与肌腱重建组术后均完成部分负重,时间分别为3.0(2.0,4.0)周和4.0(3.5,6.0)周;两组患者术后均恢复正常行走,时间分别为8.0(6.0,9.0)周和8.0(5.5,12.0)周;增强修补组与肌腱重建组术后分别有13例(63%)和13例(72%)成功重返运动,重返运动时间分别为6.0(3.5,8.0)个月和6.0(4.5,12.0)个月。两组间以上指标比较,差异无统计学意义(P均>0.05),但增强修补组相比肌腱重建组具有更快完成部分负重的趋势。增强修补组术后运动时存在不稳感1例[5%(1/19)],肌腱重建组发生1例[6%(1/18)](P>0.05);增强修补组无一例发生踝关节活动度受限,肌腱重建组发生1例[6%(1/18)](P>0.05)。结论全踝关节镜下缝线增强修补术与肌腱重建术治疗ATFL残端质量不佳的慢性踝关节不稳定,均可提高患者术后短期的足踝功能和活动水平,且前者具有操作简便、无须使用移植物等优势。
Objective To compare the efficacy of arthroscopic all-inside ligament repair with suture augmentation and ligament reconstruction with tendons in the treatment of chronic ankle instability with poor remnant quality of the anterior talofibular ligament(ATFL)tissue.Methods A retrospective cohort study was conducted to analyze the clinical data of 37 patients with chronic ankle instability treated at Huashan Hospital Affiliated to Fudan University from January 2018 to August 2020,including 34 males(34 ankles)and 3 females(3 ankles);aged 18-57 years[(32.2±7.2)years].The time from injury to operation ranged from 3-360 months[48(12,120)months].All patients underwent arthroscopic all-inside ankle stabilization surgery,of which 19 underwent ligament repair with suture augmentation(augmented repair group)and 18 underwent traditional ligament reconstruction with allograft/autograft tendons(tendon reconstruction group).The degree of ATFL injury and intra-articular lesions(osteophytes,loose bodies and cartilage damage)were recorded during the operation.The Karlsson scale and Tegner scale were evaluated before operation and at the last follow-up.The number of patients who were able to complete partial weight-bearing/return to normal walking/return to sports postoperatively and the time required were compared between the two groups.Postoperative complications were observed.Results All patients were followed up for 12-32 months[21(16,28)months].There were no significant differences in the degree of ATFL injury and intra-articular lesions(osteophytes,loose bodies and cartilage damage)seen during the operation between the two groups(all P>0.05).At the last follow-up,the Karlsson score in augmented repair group and tendon reconstruction group[95.0(90.0,98.5)points and 95.0(87.8,99.3)points]was significantly higher than the preoperative level[65.0(51.0,75.0)points and 65.0(53.3,78.0)points](all P<0.01).At the last follow-up,the Tegner score in augmented repair group and tendon reconstruction group[5.0(3.5,6.0)points and 5.0(3.3,6.0)points]were significantly higher than the preoperative level[3.0(2.0,4.0)points and 2.5(1.3,4.0)points](all P<0.01).There were no significant differences in Karlsson score and Tegner score between the two groups(all P>0.05).All patients completed partial weight-bearing after 3.0(2.0,4.0)weeks in augmented repair group and 4.0(3.5,6.0)weeks in tendon reconstruction group.All patients returned to normal walking after 8.0(6.0,9.0)weeks in augmented repair group and 8.0(5.5,12.0)weeks in tendon reconstruction group.A total of 13 patients(63%)in augmented repair group and 13 patients(72%)in tendon reconstruction group successfully returned to sports postoperatively and the time required was 6.0(3.5,8.0)months and 6.0(4.5,12.0)months,respectively.There were no significant differences in the above indicators between the two groups(all P>0.05),but augmented repair group had a trend of faster completion of partial weight-bearing than tendon reconstruction group.There was 1 patient[5%(1/19)]in augmented repair group and 1 patient[6%(1/18)]in tendon reconstruction group who reported feelings of instability during exercise postoperatively(P>0.05).None of the patients in augmented repair group had limited ankle range-of-motion,not different from 1 patient[6%(1/18)]in tendon reconstruction group(P>0.05).Conclusion In the treatment of chronic ankle instability with poor remnant quality of the anterior talofibular ligament(ATFL)tissue,both arthroscopic all-inside ligament repair with suture augmentation and ligament reconstruction with tendons can improve the short-term postoperative ankle function and activity level of the patients,and the former one has advantages such as simple operative procedures and none use of grafts.
作者
薛啸傲
陶唯楚
李倩茹
李宏
李宏云
华英汇
Xue Xiao′ao;Tao Weichu;Li Qianru;Li Hong;Li Hongyun;Hua Yinghui(Department of Sports Medicine,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;School of Kinesiology,Shanghai University of Sport,Shanghai 200438,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第7期607-612,共6页
Chinese Journal of Trauma
基金
国家自然科学基金(81871823)。
关键词
踝损伤
关节不稳定性
外侧韧带
踝
关节镜检查
Ankle injuries
Joint instability
Lateral ligament,ankle
Arthroscopy
