关节镜下Broström-Gould术治疗慢性踝关节外侧不稳

Arthroscopic Broström-Gould procedure for chronic lateral ankle instability

摘要:

目的 探讨关节镜下Brostr?m-Gould术治疗慢性踝关节外侧不稳的疗效。方法 回顾性分析2017年3月－2019年1月该院23例慢性踝关节外侧不稳患者的临床资料，患者均采用关节镜下Brostr?m-Gould术修复踝关节外侧副韧带。其中，男14例，女9例，年龄19～48岁，平均24.7岁，术前行MRI扫描和应力X线检查，术后U形石膏固定踝关节于中立位，2周后更换功能靴并开始功能锻炼，术后第６周在护踝保护下负重行走。采用美国足踝外科协会（AOFAS）评分标准及视觉模拟评分法（VAS）评估疗效。结果 术后随访13～28个月（平均19.5个月），AOFAS评分从术前（52.8±14.3）分（27～65分）增加到末次随访（91.2±6.4）分（78～100分），术前术后比较，差异有统计学意义（P <0.01）；术前VAS评分（6.9±1.7）分，明显高于末次随访时（1.4±0.8）分，术前术后比较，差异有统计学意义（P <0.01）。所有病例均无伤口感染，1例患者出现了腓浅神经损伤的症状，经口服甲钴胺胶囊10周和物理治疗，3个月后恢复。所有病例至末次随访时均未观察到踝关节不稳定征象。结论 全关节镜下Brostr?m-Gould术治疗慢性踝关节外侧不稳，近期疗效满意。

Abstract:

Objective To explore the short-term results of arthroscopic Brostr?m-Gould for chronic lateral ankle instability.Methods Retrospective analysis the clinical data of 23 patients with chronic ankle instability treated with arthroscopic Brostr?m-Gould from March 2017 to January 2019, of which 14 were male and 9 were female, with an average age of 24.7 years (range: 19～48 years old). Preoperative MRI scans and stress radiographs were taken. The ankle joint was fixed in neutral position with U-cast after operation, functional boots were replaced 2 weeks later and functional exercise began, and full weight bearing with orthosis started in 6 weeks postoperatively. Functional evaluation carried out according to the hind-foot score by American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS).Results All the patients were followed up for 13 to 28 months (an average of 19.5 months). The AOFAS scores increased from (52.8 ± 14.3) (range 27～65) preoperation to (91.2 ± 6.4) at the last follow-up (range 78～100) (P < 0.01); The preoperative VAS score (6.9 ± 1.7), which was significantly higher than (1.4 ± 0.8) at the last follow-up (P < 0.01). There was no wound infection in any of the cases, and one patient developed symptoms of superficial peroneal nerve injury. After 10 weeks of oral mecobalamin capsules and physical therapy, she recovered after 3 months. No patients experienced any recurrent episodes of ankle instability.Conclusion Arthroscopic brostrom-gould for chronic lateral ankle instability is an effectice treatment in the short-term follow-up.