[1]丁小方,徐海林,周君琳,等.关节镜下改良Brostr?m手术治疗距腓前韧带损伤的临床研究[J].中医正骨,2022,34(10):32-37.
　DING Xiaofang,XU Hailin,ZHOU Junlin,et al.A clinical study of arthroscopic modified Brostr?m procedure for treatment of anterior talofibular ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(10):32-37.
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关节镜下改良Brostr?m手术治疗距腓前韧带损伤的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年10期
页码:
32-37
栏目:
临床研究
出版日期:
2022-10-20

文章信息/Info

Title:
A clinical study of arthroscopic modified Brostr?m procedure for treatment of anterior talofibular ligament injuries
作者:
丁小方1; 徐海林2; 周君琳3; 王元利1; 芦浩2; 袁玉松2; 吕昊润1; 纪坤羽1; 杨黎黎1; 周海涛1; 杨坤1
(1.北京市隆福医院,北京 100010; 2.北京大学人民医院,北京 100044; 3.首都医科大学附属北京朝阳医院,北京 100020)
Author(s):
DING Xiaofang1; XU Hailin2; ZHOU Junlin3; WANG Yuanli1; LU Hao2; YUAN Yusong2; LYU Haorun1; JI Kunyu1; YANG Lili1; ZHOU Haitao1; YANG Kun1
1.Beijing Longfu Hospital,Beijing 100010,China 2.Peking University People's Hospital,Beijing 100044,China 3.Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China
关键词:
踝损伤;  外侧韧带; 踝;  关节镜检查;  改良Brostr?m手术;  临床试验
Keywords:
ankle injuries;  lateral ligament; ankle;  arthroscopy;  modified Brostr?m procedure;  clinical trial
摘要:
目的:观察关节镜下改良Brostr?m手术治疗距腓前韧带损伤的临床疗效和安全性。方法:回顾性分析51例距腓前韧带损伤患者的病例资料,其中采用关节镜下改良Brostr?m手术治疗23例(关节镜手术组),采用开放改良Brostr?m手术治疗28例(开放手术组)。比较2组患者的手术时间、住院时间、踝关节疼痛视觉模拟量表(visual analog scale,VAS)评分、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及并发症发生率。结果:①一般结果。关节镜手术组手术时间、住院时间均短于开放手术组[(33.8±6.7)min,(42.1±8.5)min,t=1.468,P=0.001;(2.2±1.4)d,(5.8±1.6)d,t=1.975,P=0.002]。②踝关节疼痛VAS评分。时间因素和分组因素存在交互效应(F=0.378,P=0.018); 2组患者的踝关节疼痛VAS评分总体比较,组间差异无统计学意义,即不存在分组效应(F=1.865,P=0.163); 手术前后不同时间点踝关节疼痛VAS评分的差异有统计学意义,即存在时间效应(F=1.675,P=0.000); 2组患者踝关节疼痛VAS评分随时间变化均呈下降趋势,但 2组的下降趋势不完全一致[(7.78±1.23)分,(1.23±1.24)分,(1.03±0.35)分,(1.01±0.28)分,F=0.568,P=0.000;(7.45±1.43)分,(1.45±1.87)分,(1.23±0.55)分,(1.04±0.37)分,F=1.358,P=0.000]; 术前及术后6个月、12个月,2组患者踝关节疼痛VAS评分比较,组间差异无统计学意义(t=2.987,P=0.055; t=1.654,P=2.542; t=0.015,P=0.078); 术后3个月,关节镜手术组患者踝关节疼痛VAS评分低于开放手术组(t=1.267,P=0.023)。③AOFAS踝与后足评分。时间因素和分组因素存在交互效应(F=2.693,P=0.027); 2组患者的AOFAS踝与后足评分总体比较,组间差异无统计学意义,即不存在分组效应(F=1.983,P=0.106); 手术前后不同时间点AOFAS踝与后足评分的差异有统计学意义,即存在时间效应(F=34.623,P=0.000); 2组患者AOFAS踝与后足评分随时间变化均呈上升趋势,但2组的上升趋势不完全一致[(48.19±12.89)分,(89.20±8.96)分,(90.24±7.89)分,(91.34±9.67)分,F=25.623,P=0.000;(49.35±13.28)分,(86.78±12.34)分,(88.78±9.78)分,(91.43±7.98)分,F=33.275,P=0.000]; 术前、术后12个月,2组患者AOFAS踝与后足评分比较,组间差异无统计学意义(t=2.145,P=0.056; t=2.879,P=0.389); 术后3个月、6个月,关节镜手术组患者AOFAS踝与后足评分均高于开放手术组(t=1.346,P=0.014; t=1.874,P=0.028)。④并发症发生率。关节镜手术组出现腓浅神经激惹症状1例,给予营养神经药物治疗后症状消失; 出现慢性局部疼痛综合征1例,给予非甾体抗炎药口服及理疗后症状消失。开放手术组出现切口延迟愈合1例,给予加强换药处理后切口愈合; 出现深静脉血栓形成1例,给予抗凝溶栓治疗后血栓消失; 出现慢性局部疼痛综合征1例,给予非甾体抗炎药口服及理疗后症状消失。2组患者并发症发生率比较,差异无统计学意义(χ2=2.526,P=0.112)。结论:采用关节镜下改良Brostr?m手术治疗距腓前韧带损伤,与开放改良Brostr?m手术比较,手术时间和住院时间短,踝关节疼痛缓解和踝关节功能恢复快。
Abstract:
Objective:To observe the clinical efficacy and safety of arthroscopic modified Brostr?m procedure for treatment of anterior talofibular ligament(ATFL)injuries.Methods:The clinical data of 51 patients with ATFL injuries were retrospectively analyzed.Twenty-three patients were treated with arthroscopic modified Brostr?m procedure(arthroscopic procedure group),and 28 cases with open modified Brostr?m procedure(open procedure group).The operative time,hospital stays,ankle pain visual analog scale(VAS)score,American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and complication incidence were compared between the 2 groups.Results:①The operative time and hospital stays were shorter in arthroscopic procedure group compared to open procedure group(33.8±6.7 vs 42.1±8.5 minutes,t=1.468,P=0.001; 2.2±1.4 vs 5.8±1.6 days,t=1.975,P=0.002).②There was interaction between time factor and group factor in ankle pain VAS score(F=0.378,P=0.018).There was no statistical difference in the ankle pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=1.865,P=0.163).There was statistical difference in the ankle pain VAS scores between different timepoints before and after the procedure,in other words,there was time effect(F=1.675,P=0.000).The ankle pain VAS scores presented a downward trend over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(7.78±1.23,1.23±1.24,1.03±0.35,1.01±0.28,F=0.568,P=0.000; 7.45±1.43,1.45±1.87,1.23±0.55,1.04±0.37 points,F=1.358,P=0.000).There was no statistical difference in the ankle pain VAS scores between the 2 groups before the procedure and at 6 and 12 months after the procedure(t=2.987,P=0.055; t=1.654,P=2.542; t=0.015,P=0.078),however,at 3 months after the procedure,the ankle pain VAS scores were lower in arthroscopic procedure group compared to open procedure group(t=1.267, P=0.023).③There was interaction between time factor and group factor in AOFAS ankle-hindfoot score(F=2.693,P=0.027).There was no statistical difference in AOFAS ankle-hindfoot scores between the 2 groups in general,in other words,there was no group effect(F=1.983,P=0.106).There was statistical difference in AOFAS ankle-hindfoot scores between different timepoints before and after the procedure,namely,there was time effect(F=34.623,P=0.000).The AOFAS ankle-hindfoot scores showed an upward trend over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(48.19±12.89,89.20±8.96,90.24±7.89,91.34±9.67,F=25.623,P=0.000; 49.35±13.28,86.78±12.34,88.78±9.78,91.43±7.98 points,F=33.275,P=0.000).Before the procedure and at 12 months after the procedure,there was no statistical difference in AOFAS ankle-hindfoot scores between the 2 groups(t=2.145,P=0.056; t=2.879,P=0.389),however,at 3 and 6 months after the procedure,the AOFAS ankle-hindfoot scores were higher in arthroscopic procedure group compared to open procedure group(t=1.346,P=0.014; t=1.874,P=0.028).④The superficial peroneal nerve irritation(1 case)and chronic local pain syndrome(1 case)were found in arthroscopic procedure group,and the symptoms disappeared after treatment with neurotrophic drugs as well as oral administration of non-steroidal anti-inflammatory drugs and physical therapy respectively.The incision delayed healing(1 case),deep vein thrombosis(1 case)and chronic local pain syndrome(1 case)were found in open procedure group,and the incision healed,the thrombus and the pain symptoms disappeared after treatment with dressing change,anticoagulant and thrombolytic therapy as well as oral administration of non-steroidal anti-inflammatory drugs and physical therapy respectively.There was no statistical difference in complication incidences between the 2 groups(χ2=2.526,P=0.112).Conclusion:The arthroscopic modified Brostr?m procedure has the advantages of shorter operative time and hospital stays,faster ankle pain relief and ankle function recovery compared to open modified Brostr?m procedure in treatment of ATFL injuries.

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备注/Memo

备注/Memo:
基金项目:北京市科技计划项目(Z181100001718159) 通讯作者:徐海林 E-mail:dxfleon@sina.com
更新日期/Last Update: 1900-01-01