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[1]丁小方,徐海林,周君琳,等.關(guān)節(jié)鏡下改良Brostr?m手術(shù)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(guān)節(jié)鏡下改良Brostr?m手術(shù)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(rùn)1; 紀(jì)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(xué)人民醫(yī)院,北京 100044; 3.首都醫(yī)科大學(xué)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(guān)鍵詞:
踝損傷;  外側(cè)韌帶; 踝;  關(guān)節(jié)鏡檢查;  改良Brostr?m手術(shù);  臨床試驗(yàn)
Keywords:
ankle injuries;  lateral ligament; ankle;  arthroscopy;  modified Brostr?m procedure;  clinical trial
摘要:
目的:觀察關(guān)節(jié)鏡下改良Brostr?m手術(shù)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(guān)節(jié)鏡下改良Brostr?m手術(shù)治療23例(關(guān)節(jié)鏡手術(shù)組),采用開放改良Brostr?m手術(shù)治療28例(開放手術(shù)組)。比較2組患者的手術(shù)時(shí)間、住院時(shí)間、踝關(guān)節(jié)疼痛視覺模擬量表(visual analog scale,VAS)評(píng)分、美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足評(píng)分及并發(fā)癥發(fā)生率。結(jié)果:①一般結(jié)果。關(guān)節(jié)鏡手術(shù)組手術(shù)時(shí)間、住院時(shí)間均短于開放手術(shù)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(guān)節(jié)疼痛VAS評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=0.378,P=0.018); 2組患者的踝關(guān)節(jié)疼痛VAS評(píng)分總體比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=1.865,P=0.163); 手術(shù)前后不同時(shí)間點(diǎn)踝關(guān)節(jié)疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=1.675,P=0.000); 2組患者踝關(guān)節(jié)疼痛VAS評(píng)分隨時(shí)間變化均呈下降趨勢(shì),但 2組的下降趨勢(shì)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(shù)前及術(shù)后6個(gè)月、12個(gè)月,2組患者踝關(guān)節(jié)疼痛VAS評(píng)分比較,組間差異無統(tǒng)計(jì)學(xué)意義(t=2.987,P=0.055; t=1.654,P=2.542; t=0.015,P=0.078); 術(shù)后3個(gè)月,關(guān)節(jié)鏡手術(shù)組患者踝關(guān)節(jié)疼痛VAS評(píng)分低于開放手術(shù)組(t=1.267,P=0.023)。③AOFAS踝與后足評(píng)分。時(shí)間因素和分組因素存在交互效應(yīng)(F=2.693,P=0.027); 2組患者的AOFAS踝與后足評(píng)分總體比較,組間差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=1.983,P=0.106); 手術(shù)前后不同時(shí)間點(diǎn)AOFAS踝與后足評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=34.623,P=0.000); 2組患者AOFAS踝與后足評(píng)分隨時(shí)間變化均呈上升趨勢(shì),但2組的上升趨勢(shì)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(shù)前、術(shù)后12個(gè)月,2組患者AOFAS踝與后足評(píng)分比較,組間差異無統(tǒng)計(jì)學(xué)意義(t=2.145,P=0.056; t=2.879,P=0.389); 術(shù)后3個(gè)月、6個(gè)月,關(guān)節(jié)鏡手術(shù)組患者AOFAS踝與后足評(píng)分均高于開放手術(shù)組(t=1.346,P=0.014; t=1.874,P=0.028)。④并發(fā)癥發(fā)生率。關(guān)節(jié)鏡手術(shù)組出現(xiàn)腓淺神經(jīng)激惹癥狀1例,給予營(yíng)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(shù)組出現(xiàn)切口延遲愈合1例,給予加強(qiáng)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(jì)學(xué)意義(χ2=2.526,P=0.112)。結(jié)論:采用關(guān)節(jié)鏡下改良Brostr?m手術(shù)治療距腓前韌帶損傷,與開放改良Brostr?m手術(shù)比較,手術(shù)時(shí)間和住院時(shí)間短,踝關(guān)節(jié)疼痛緩解和踝關(guān)節(jié)功能恢復(fù)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.

參考文獻(xiàn)/References:

[1] 唐康來.注重慢性踝關(guān)節(jié)不穩(wěn)的診斷和治療[J].中國(guó)骨傷,2012,25(8):623-626.
[2] 楊勇,呂煒,楊元疆.踝關(guān)節(jié)鏡輔助下改良Brostrom法治療慢性踝關(guān)節(jié)不穩(wěn)25例[J].海南醫(yī)學(xué),2022,33(1):28-31.
[3] COTTOM J M,RIGBY R B.The “all inside”arthroscopic Broström procedure:a prospective study of 40 consecutive patients[J].J Foot Ankle Surg,2013,52(5):568-574.
[4] 張琰冰,李永樂,張緒斌,等.“三明治”術(shù)式聯(lián)合關(guān)節(jié)鏡治療踝關(guān)節(jié)慢性不穩(wěn)的臨床療效[J].創(chuàng)傷外科雜志,2022,24(4):285-288.
[5] COETZEE J C,ELLINGTON J K,RONAN J A,et al.Functional results of open Broström ankle ligament repair augmented with a suture tape[J].Foot Ankle Int,2018,39(3):304-310.
[6] LOHRER H,BONSIGNORE G,DORN-LANGE N,et al.Stabilizing lateral ankle instability by suture tape -a cadaver study[J].J Orthop Surg Res,2019,14(1):175.
[7] PITTS C C,MCKISSACK H M,ANDERSON M C,et al.Anatomical structures at risk in the arthroscopic Broström-Gould procedure:a cadaver study[J].Foot Ankle Surg,2020,26(3):343-346.
[8] GUELFI M,ZAMPERETTI M,PANTALONE A,et al.Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability:a systematic review[J].Foot Ankle Surg,2018,24(1):11-18.
[9] LOPES R,ANDRIEU M,CORDIER G,et al.Arthroscopic treatment of chronic ankle instability:prospective study of outcomes in 286 patients[J].Orthop Traumatol Surg Res,2018,104(8S):S199-S205.
[10] ACEVEDO J I,MANGONE P.Arthroscopic brostrom technique[J].Foot Ankle Int,2015,36(4):465-473.
[11] BAUMBACH S F,BRAUNSTEIN M,HERTERICH V,et al.Arthroscopic repair of chronic lateral ankle instability[J].Oper Orthop Traumatol,2019,31(3):201-210.
[12] NERY C,RADUAN F,DEL BUONO A,et al.Arthroscopic-assisted Broström-Gould for chronic ankle instability:a long-term follow-up[J].Am J Sports Med,2011,39(11):2381-2388.
[13] 嚴(yán)廣斌.AOFAS踝-后足評(píng)分系統(tǒng)[J].中華關(guān)節(jié)外科雜志(電子版),2014,8(4):557.
[14] BROSTRÖM L.Sprained ankles.VI.Surgical treatment of “chronic”ligament ruptures[J].Acta Chir Scand,1966,132(5):551-565.
[15] GOULD N,SELIGSON D,GASSMAN J.Early and late repair of lateral ligament of the ankle[J].Foot Ankle,1980,1(2):84-89.
[16] 易剛,扶世杰,楊靜,等.全關(guān)節(jié)鏡下與改良開放式Broström錨釘修復(fù)距腓前韌帶的療效比較[J].中國(guó)修復(fù)重建外科雜志,2019,33(12):1503-1509.
[17] MOORTHY V,SAYAMPANATHAN A A,YEO N E M,et al.Clinical outcomes of open versus arthroscopic Broström procedure for lateral ankle instability:a meta-analysis[J].J Foot Ankle Surg,2021,60(3):577-584.

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備注/Memo

備注/Memo:
基金項(xiàng)目:北京市科技計(jì)劃項(xiàng)目(Z181100001718159) 通訊作者:徐海林 E-mail:[email protected]
更新日期/Last Update: 1900-01-01