[1]杨宗宇,刘非,崔亮,等.踝关节镜手术联合改良Bromstrm术治疗慢性踝关节不稳合并骨软骨损伤[J].中医正骨,2017,29(08):72-75.
点击复制

踝关节镜手术联合改良Bromström术治疗慢性踝关节不稳合并骨软骨损伤()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年08期
页码:
72-75
栏目:
临床报道
出版日期:
2017-08-20

文章信息/Info

作者:
杨宗宇; 刘非; 崔亮; 刘核达; 左俊水; 李森田
河北省沧州中西医结合医院,河北 沧州 061001
关键词:
踝损伤;  外侧韧带; 踝;  关节镜检查;  软骨损伤;  改良Bromströ; m术
摘要:
目的:观察踝关节镜手术联合改良Bromström术治疗慢性踝关节不稳合并骨软骨损伤的临床疗效。方法:2013年6月至2016年5月,采用踝关节镜手术联合改良Bromström术治疗慢性踝关节不稳合并骨软骨损伤患者36例,男20例、女16例; 年龄18～45岁,中位数30岁; 左踝18例,右踝18例。病程6～60个月,中位数16个月。术后随访观察切口愈合、临床症状和体征改善、踝关节功能和活动能力恢复及距骨倾斜角改善情况。结果:所有患者均获随访,随访时间13～21个月,中位数16个月; 切口均甲级愈合; 均未发生踝关节再扭伤,踝关节慢性肿痛均消失,踝关节内翻应力试验及前抽屉试验均阴性。末次随访时,距骨倾斜角由术前11.78°±1.59°减小至4.36°±1.73°,美国足踝关节外科协会踝与后足功能评分由术前(47.94±2.38)分升至(88.39±2.17)分,Tegner活动水平评分由术前(4.45±1.44)分升至(5.94±1.09)分。结论:采用踝关节镜手术联合改良Bromström术治疗慢性踝关节不稳合并骨软骨损伤,操作简单,创伤小,能明显减轻踝关节肿胀、疼痛等症状和体征,恢复踝关节的稳定性,改善踝关节活动能力,促进踝关节功能的恢复,值得临床推广应用。

参考文献/References:

[1] GRASS R.Injuries of the inferior tibiofibular syndesmosis[J].Der Unfallchirurg,2000,103(7):519.
[2] 谢兴,胡跃林,焦晨,等.55例踝关节外侧副韧带损伤合并外踝撕脱骨折的手术治疗分析[J].中华骨与关节外科杂志,2015,8(1):66-70.
[3] 杨雷,陆伟,吴冰,等.半腱肌腱与同种异体肌腱解剖重建踝关节外侧副韧带治疗慢性踝关节不稳的疗效比较[J].中国骨与关节损伤杂志,2016,31(5):489-492.
[4] 王雪,王成伟,郭鹏超,等.腓骨长肌及同种异体肌腱重建踝关节外侧副韧带的临床对比研究[J].中华骨与关节外科杂志,2015,8(4):314-319.
[5] 张言,梁晓军.慢性踝关节外侧不稳的解剖修复治疗进展[J].中国修复重建外科杂志,2016,30(12):1551-1555.
[6] 董相宇,曾效力,何秀珍,等.MRI和高频超声对踝关节外侧副韧带损伤的诊断价值比较[J].现代医用影像学,2015,24(2):140-144.
[7] BOHNDORF K.OSTEOCHONDRITIS(osteochondmsis)dissecans:a review and new MRI classification[J].Eur Radiol,1998,8(1):103-112.
[8] LI X,KILLIE H,GUERRERO P,et al.Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete:functional outcomes after the modified brostrom repair using suture anchors[J].Am J Sports Med,1994,37(3):488-494. 中医正骨2017年8月第29卷第8期 J Trad Chin Orthop Trauma,2017,Vol.29,No.8(总635) (总636)中医正骨2017年8月第29卷第8期 J Trad Chin Orthop Trauma,2017,Vol.29,No.8
[9] KITAOKA HB,ALEXANDER IJ,ADELAAR RS.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,l5(7):349-393.
[10] HAMBLY K.The use of the Tegner Activity Scale for articular cartilage repair of the knee: a systematic review[J].Knee Surg Sports Traumatol Arthrosc,2011,19(4):604-614.
[11] DIMMICK S,KENNEDY D,DAUNT N.Evaluation of thickness and appearance of anterior talofibular and calcaneofibular ligaments in normal versus abnormal ankles with MRI[J].J Med Imaging Radiat Oncol,2008,52(6):559-563.
[12] TAKAO M,OAE K,UCHIO Y,et al.Anatomical Reconstruction of the lateral ligaments of the ankle with a gracilis autograft:a new technique using an interference fit anchoring system[J].Am J Sports Med,2005,33(6):814-823.
[13] VRIES JD,KRIPS R,SIEREVELT IN,et al.Interventions for treating chronic ankle instability[J].Cochrane Database Syst Rev,2003,4(8):CD004124.
[14] MAFFULLI N,FERRAN NA.Management of acute and chronic ankle instability[J].J Am Acad Orthop Surg,2008,16(10):608-615.
[15] BUERER Y,WINKLER M,BURN A,et al.Evaluation of a modified Broström-Gould procedure for treatment of chronic lateral ankle instability:A retrospective study with critical analysis of outcome scoring[J].Foot Ankle Surg,2013,19(1):36-41.
[16] CHO BK,KIM YM,PARK KJ,et al.A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability[J].Foot Ankle Int,2015,36(2):172-179.
[17] 杨克强,黄长明,谷孝将,等.自体半腱肌腱重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳[J].中国骨与关节损伤杂志,2014,29(8):791-793.
[18] 罗永忠,吴波,赵新刚,等.半腱肌腱联合锚钉重建外侧副韧带治疗慢性踝关节不稳的临床观察[J].中国矫形外科杂志,2013,21(20):2056-2059.
[19] GIZA E,NATHE R,NATHE T,et al.Strength of bone tunnel versus suture anchor and push-lock construct in Broström repair[J].Am J Sports Med,2012,40(6):1419-1423.
[20] 华英汇,陈世益.慢性踝关节不稳定的外科治疗进展[J].中国医学前沿杂志:电子版,2013,5(3):8-11.
[21] 张金平,何川,王福科,等.骨锚钉系统在修复踝关节外侧副韧带损伤中的应用[J].当代医学,2016,22(17):5-6,7.
[22] 江东,胡跃林,焦晨,等.慢性踝关节外侧不稳合并骨软骨损伤术后中期随访报告[J].中国微创外科杂志,2015,15(8):673-675.
[23] GOLDITZ T,STEIB S,PFEIFER K,et al.Functional ankle instability as a risk factor for osteoarthritis:using T2-mapping to analyze early cartilage degeneration in the ankle joint of young athletes[J].Osteoarthritis and Cartilage,2014,22(10):1377-1385.
[24] LEE J,HAMILTON G,FORD L.Associated intra-articular ankle pathologies in patients with chronic lateral ankle instability:arthroscopic findings at the time of lateral ankle Reconstruction[J].Foot Ankle Spec,2011,4(5):284-289.
[25] ELIAS I,ZOGA AC,MORRISON WB,et al.Osteochondral lesions of the talus:localization and morphologic data from 424 patients using a novel anatomical grid scheme[J].Foot Ankle Int,2007,28(2):154-161.
[26] HUA Y,CHEN S,LI Y,et al.Combination of modified Broström procedure with ankle arthroscopy for chronic ankle instability accompanied by intra-articular symptoms[J].Arthroscopy,2010,26(4):524-528.
[27] GREGUSH RV,FERKEL RD.Treatment of the unstable ankle with an osteochondral lesion:results and long-term follow-up[J].Am J Sports Med,2010,38(4):782-790.
[28] 史尉利,郭秦炜,赵峰,等.Hepple V型距骨骨软骨损伤的影像学特点及关节镜下表现[J].中国运动医学杂志,2015,34(8):726-729.
[29] CHA SD,KIM HS,CHUNG ST,et al.Intra-articular lesions in chronic lateral ankle instability:comparison of arthroscopy with magnetic resonance imaging findings[J].Clin Orthop Surg,2012,4(4):293-299.
[30] 张跃钟,胡跃林,江东.关节镜在慢性踝关节不稳治疗中的应用[J].中国微创外科杂志,2016,16(9):845-847.
[31] YASUI Y,TAKAO M,MIYAMOTO W,et al.Simultaneous surgery for chronic lateral ankle instability accompanied by only subchondral bone lesion of talus[J].Arch Orthop Trauma Surg,2014,134(6):821-827.
[32] KOMENDA GA,FERKEL RD.Arthroscopic findings associated with the unstable ankle[J].Foot Ankle Int,1999,20(11):708-713.

相似文献/References:

[1]韦健,容安,周建飞,等.腓骨延长术治疗外踝开放性骨缺损[J].中医正骨,2016,28(10):62.
[2]邬博来,辛景义.距腓前韧带和跟腓韧带解剖重建治疗习惯性踝关节扭伤[J].中医正骨,2017,29(03):60.
[3]董秀珍.腓骨头复合组织瓣移植治疗儿童内踝骨及皮肤软组织缺损[J].中医正骨,2017,29(06):59.
[4]杨宗宇,刘非,崔亮,等.同种异体半腱肌解剖重建距腓前韧带和跟腓韧带治疗慢性踝关节外侧不稳[J].中医正骨,2017,29(09):64.
[5]尚林,王翔宇,徐俊峰,等.第三腓骨肌重建距腓前韧带结合中药薰洗治疗慢性踝关节外侧不稳[J].中医正骨,2018,30(06):58.
[6]张鑫,刘辉,刘波.郑氏形意拳配合中药薰洗治疗慢性踝关节不稳[J].中医正骨,2018,30(12):50.
[7]俞益火,谢嫚花,周文军,等.中医理筋正骨手法治疗慢性踝关节损伤的临床研究[J].中医正骨,2019,31(03):20.
　YU Yihuo,XIE Manhua,ZHOU Wenjun,et al.A clinical study of TCM sinew-adjusting and bone-setting manipulation for treatment of chronic ankle injury[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(08):20.
[8]康永奇,李豪,李华兵.切开复位钢板内固定治疗Pilon骨折[J].中医正骨,2019,31(06):60.
[9]刘晓东,李朝晖,张阳.踝上截骨结合外侧副韧带修复治疗合并踝关节外侧不稳的创伤性踝关节炎[J].中医正骨,2019,31(11):55.
[10]赵洪洲,范桐顺,刘丽民.非单纯性下胫腓联合损伤评估的研究进展[J].中医正骨,2020,32(09):54.
[11]邓刚,蔡幸健,王一海,等.踝关节镜下清理联合自体肌腱移植治疗慢性踝关节外侧不稳[J].中医正骨,2020,32(06):69.
[12]李琦,尚林,马富强,等.第三腓骨肌肌腱解剖重建距腓前韧带治疗陈旧性距腓前韧带损伤[J].中医正骨,2021,33(04):71.
　LI Qi,SHANG Lin,MA Fuqiang,et al.Anatomical reconstruction of anterior talofibular ligaments with peroneus tertius tendon for treatment of old anterior talofibular ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(08):71.
[13]王金杰,庄汝杰.Endobutton技术在慢性踝关节外侧不稳外侧韧带重建术中的应用[J].中医正骨,2021,33(05):71.
　WANG Jinjie,ZHUANG Rujie.Application of Endobutton technique in surgery of ankle lateral ligament reconstruction for treatment of chronic lateral ankle instability[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(08):71.
[14]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.
　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(08):32.
[15]汪青,黄昊强,钱胤华,等.关节镜下改良Brostr?m-Gould术结合足印区重建治疗慢性踝关节外侧不稳[J].中医正骨,2023,35(07):72.
[16]杜俊锋,陈卫东,梁林,等.踝关节镜下韧带解剖重建术治疗距腓前韧带距骨侧断裂[J].中医正骨,2023,35(12):65.

更新日期/Last Update: 2017-12-29