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[1]丁小方,徐海林,周君琳,等.關節(jié)鏡下改良Brostr?m手術治療距腓前韌帶損傷的臨床研究[J].中醫(yī)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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關節(jié)鏡下改良Brostr?m手術治療距腓前韌帶損傷的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年10期
頁碼:
32-37
欄目:
臨床研究
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; 蘆浩2; 袁玉松2; 呂昊潤1; 紀坤羽1; 楊黎黎1; 周海濤1; 楊坤1
(1.北京市隆福醫(yī)院,北京 100010; 2.北京大學人民醫(yī)院,北京 100044; 3.首都醫(yī)科大學附屬北京朝陽醫(yī)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
關鍵詞:
踝損傷;  外側(cè)韌帶; 踝;  關節(jié)鏡檢查;  改良Brostr?m手術;  臨床試驗
Keywords:
ankle injuries;  lateral ligament; ankle;  arthroscopy;  modified Brostr?m procedure;  clinical trial
摘要:
目的:觀察關節(jié)鏡下改良Brostr?m手術治療距腓前韌帶損傷的臨床療效和安全性。方法:回顧性分析51例距腓前韌帶損傷患者的病例資料,其中采用關節(jié)鏡下改良Brostr?m手術治療23例(關節(jié)鏡手術組),采用開放改良Brostr?m手術治療28例(開放手術組)。比較2組患者的手術時間、住院時間、踝關節(jié)疼痛視覺模擬量表(visual analog scale,VAS)評分、美國足與踝關節(jié)協(xié)會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評分及并發(fā)癥發(fā)生率。結(jié)果:①一般結(jié)果。關節(jié)鏡手術組手術時間、住院時間均短于開放手術組[(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踝關節(jié)疼痛VAS評分。時間因素和分組因素存在交互效應(F=0.378,P=0.018); 2組患者的踝關節(jié)疼痛VAS評分總體比較,組間差異無統(tǒng)計學意義,即不存在分組效應(F=1.865,P=0.163); 手術前后不同時間點踝關節(jié)疼痛VAS評分的差異有統(tǒng)計學意義,即存在時間效應(F=1.675,P=0.000); 2組患者踝關節(jié)疼痛VAS評分隨時間變化均呈下降趨勢,但 2組的下降趨勢不完全一致[(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]; 術前及術后6個月、12個月,2組患者踝關節(jié)疼痛VAS評分比較,組間差異無統(tǒng)計學意義(t=2.987,P=0.055; t=1.654,P=2.542; t=0.015,P=0.078); 術后3個月,關節(jié)鏡手術組患者踝關節(jié)疼痛VAS評分低于開放手術組(t=1.267,P=0.023)。③AOFAS踝與后足評分。時間因素和分組因素存在交互效應(F=2.693,P=0.027); 2組患者的AOFAS踝與后足評分總體比較,組間差異無統(tǒng)計學意義,即不存在分組效應(F=1.983,P=0.106); 手術前后不同時間點AOFAS踝與后足評分的差異有統(tǒng)計學意義,即存在時間效應(F=34.623,P=0.000); 2組患者AOFAS踝與后足評分隨時間變化均呈上升趨勢,但2組的上升趨勢不完全一致[(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]; 術前、術后12個月,2組患者AOFAS踝與后足評分比較,組間差異無統(tǒng)計學意義(t=2.145,P=0.056; t=2.879,P=0.389); 術后3個月、6個月,關節(jié)鏡手術組患者AOFAS踝與后足評分均高于開放手術組(t=1.346,P=0.014; t=1.874,P=0.028)。④并發(fā)癥發(fā)生率。關節(jié)鏡手術組出現(xiàn)腓淺神經(jīng)激惹癥狀1例,給予營養(yǎng)神經(jīng)藥物治療后癥狀消失; 出現(xiàn)慢性局部疼痛綜合征1例,給予非甾體抗炎藥口服及理療后癥狀消失。開放手術組出現(xiàn)切口延遲愈合1例,給予加強換藥處理后切口愈合; 出現(xiàn)深靜脈血栓形成1例,給予抗凝溶栓治療后血栓消失; 出現(xiàn)慢性局部疼痛綜合征1例,給予非甾體抗炎藥口服及理療后癥狀消失。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=2.526,P=0.112)。結(jié)論:采用關節(jié)鏡下改良Brostr?m手術治療距腓前韌帶損傷,與開放改良Brostr?m手術比較,手術時間和住院時間短,踝關節(jié)疼痛緩解和踝關節(jié)功能恢復快。
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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備注/Memo:
基金項目:北京市科技計劃項目(Z181100001718159) 通訊作者:徐海林 E-mail:[email protected]
更新日期/Last Update: 1900-01-01