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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (02): 111 -115. doi: 10.3877/cma.j.issn.1674-6899.2023.02.010

论著

改良前方双入路全踝关节镜下陈旧距腓前韧带损伤修复的临床疗效分析
刁乃成1, 尹合勇1, 戴益科1, 李智尧1, 马立峰1, 张京新1,†()   
  1. 1. 100050　北京，首都医科大学附属北京友谊医院骨科
  • 收稿日期:2023-02-02 出版日期:2023-04-30
  • 通信作者: 张京新
  • 基金资助:
    国家自然科学基金青年项目(82002285)

Evaluation of clinical outcomes of chronic anterior talofibular ligament repair using ankle arthroscopic all-inside technique with modified anterior double portals

Naicheng Diao1, Heyong Yin1, Yike Dai1, Zhiyao Li1, Lifeng Ma1, Jingxin Zhang1,†()   

  1. 1. Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Received:2023-02-02 Published:2023-04-30
  • Corresponding author: Jingxin Zhang
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目的

探讨改良前内侧中线入路联合前外侧辅助入路全踝关节镜下修复距腓前韧带损伤的临床效果。

方法

回顾性分析2021年7月至2022年5月期间因距腓前韧带损伤收治于首都医科大学附属北京友谊医院的38例患者资料，受伤时间3~36个月，平均(18.47±8.74)个月。所有患者均有手术指征，采用改良前方双入路全踝关节镜下带线锚钉解剖修复距腓前韧带。通过随访术后疼痛视觉模拟评分(visual analogue scale，VAS)、美国足踝外科协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝关节功能评分、踝关节稳定性(前抽屉试验)、并发症(伤口愈合、血管神经损伤、韧带再次断裂、感染等)等对手术的临床疗效进行评估。

结果

38例患者均成功完成手术，随访6~16个月。患者手术切口均Ⅰ期愈合，未发生血管神经损伤、韧带再次断裂、感染等并发症。术后体格检查患者均获得较好的踝关节稳定性，前抽屉试验均为阴性。末次随访时VAS(1.02±0.92)分，明显低于术前VAS(5.66±1.02)分，差异有统计学意义(P<0.05)；末次随访时AOFAS踝关节功能评分(91.29±3.98)分，显著优于术前AOFAS踝关节功能评分(52.47±7.61)分，差异有统计学意义(P<0.05)。

结论

改良前方双入路全踝关节镜下距腓前韧带修复具有创伤小、技术可靠、视野清楚、操作简单等优点，可获得满意的临床效果，显著改善患者踝关节功能和稳定性。

关键词: 踝关节镜, 距腓前韧带损伤, 踝关节不稳, 韧带修复
Objective

To explore the clinical effect of anterior talofibular ligament (ATFL) repair using ankle arthroscopic all-inside technique with modified anteromedial midline and auxiliary anterolateral portals.

Methods

The data of 38 patients admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from Jul. 2021 to May 2022 due to ATFL injuries were retrospectively analyzed. The injury time was 3-36 months, with an average of (18.47±8.74) months. All patients had indications for surgery, and the ATFL was repaired with an anchor by using arthroscopic all-inside technique with modified anterior double portals. The clinical outcome was evaluated by follow-up VAS pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle function scores, ankle stability (anterior drawer test), and complications (wound healing, vascular and nerve injury, ligament re-rupture, and infection).

Results

All 38 patients underwent successful surgery and were followed up for 6-16 months. All the surgical incisions healed at stage I, and no complications such as infection, vascular and nerve injury, and ligament re-rupture occurred. All the patients obtained good ankle joint stability after physical examination, and the anterior drawer test was negative. The VAS score at the last follow-up was (1.02±0.92) points, which was significantly lower than that before surgery (5.66±1.02) points, and the difference was statistically significant (P< 0.05). The AOFAS score at the last follow-up was (91.29±3.98) points, which was significantly better than that before surgery (52.47±7.61) points, and the difference was statistically significant (P<0.05).

Conclusions

Arthroscopic all-inside ATFL repair with modified anterior double-portals has the advantages of minimal invasion, reliable, clear field of vision and simple operation, and can obtain satisfactory clinical results, significantly improving the function and stability of the ankle joint.

Key words: Ankle arthroscope, Anterior talofibular ligament injury, Ankle instability, Ligament repair
图1 前内侧中线入路
图2 前外侧辅助入路
图3 探查距腓前韧带撕裂
图4 腓骨远端置入锚钉
图5 缝合固定距腓前韧带
表1 患者术前与末次随访行走时踝关节疼痛、关节功能评分和关节稳定性比较
时间 例数 VAS(分，±s) AOFAS踝关节功能评分(分，±s) 前抽屉试验[例(%)]
阴性 阳性
术前 38 5.66±1.02 52.47±7.61 0(0.0) 38(100.0)
末次随访 38 1.02±0.92 91.29±3.98 38(100.0) 0(0.0)
t/χ2值   18.88 －27.849 76.000
P值   <0.001 <0.001 <0.001
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