|
|
镜下距腓前韧带修复联合富血小板血浆治疗慢性外侧踝关节不稳的疗效分析
|
Abstract:
目的：观察关节镜下距腓前韧带(anterior talofibular ligament, ATFL)带线锚钉固定联合富血小板血浆(PRP)治疗慢性外侧踝关节不稳(Chronic Lateral Ankle Instability, CLAI)的疗效。方法：回顾性分析我院符合纳入标准的34名患者，其中13名患者行关节镜下ATFL带线锚钉固定联合PRP治疗，21例患者行单纯ATFL带线铆钉固定治疗。对比患者术前术后疼痛视觉模拟评分(VAS)、美国足踝骨科协会(AOFAS)踝与后足评分及日本足踝外科学会(JSSF)评分，评价临床治疗效果。行踝关节应力位X线片检查，测量距骨倾斜角和距骨前移。结果：术后全部患者均获得随访，平均随访(17.18 ± 3.71)个月。术后3个月VAS评分两组具有显著差异(P < 0.05)。JSSF评分差异有统计学意义(P = 0.013)。结论：关节镜下ATFL带线锚钉固定联合PRP治疗CLAI，术后可减轻踝关节疼痛、增强踝关节稳定性。
Objective: To observe the effect of suture anchor fixation of anterior talofibular ligament combined with platelet rich plasma (PRP) in the treatment of chronic lateral ankle instability. Methods: 34 patients who met the inclusion criteria in our hospital were retrospectively analyzed. Among them, 13 patients were treated with ATFL wire-anchor fixation combined with PRP under arthroscopy, and 21 patients were treated with ATFL wire-rivets alone. The preoperative and postoperative pain visual analog scale (VAS), American Foot and Ankle Orthopaedic Association (AOFAS) ankle and posterior foot score and Japanese Foot and Ankle Surgery Society (JSSF) score were compared to evaluate the clinical treatment effect. Ankle stress radiographs were performed to measure the An-gle of talus tilt and talus anterograde. Results: All patients were followed up for an average of (17.18 ± 3.71) months. VAS scores 3 months after operation were significantly different between the two groups (P < 0.05). JSSF score showed statistically significant difference (P = 0.013). Conclusion: Ar-throscopic ATFL wire anchor fixation combined with PRP in the treatment of CLAI can reduce ankle pain and enhance ankle stability.
| [1] | Gribble, P.A., Terada, M., Beard, M.Q., et al. (2016) Prediction of Lateral Ankle Sprains in Football Players Based on Clinical Tests and Body Mass Index. The American Journal of Sports Medicine, 44, 460-467.
https://doi.org/10.1177/0363546515614585 |
| [2] | 陈明亮, 谷成毅, 徐留海, 等. 踝关节外侧副韧带损伤诊断治疗研究进展[J]. 中国运动医学杂志, 2019, 38(2): 152-158. |
| [3] | Takao, M., Matsui, K., Stone, J.W., et al. (2016) Arthroscopic Anterior Talofibular Ligament Repair for Lateral Instability of the Ankle. Knee Surgery, Sports Trauma-tology, Arthroscopy, 24, 1003-1006.
https://doi.org/10.1007/s00167-015-3638-0 |
| [4] | 赵露婷, 王剑雄, 方其林. 富血小板血浆治疗膝骨关节炎的研究进展[J]. 重庆医学, 2018, 47(16): 2216-2218+2222. |
| [5] | Brokelman, R.B., Van Loon, C.J. and Boog, G.J. (2008) Surgeon Satisfaction Agreement after Total Knee Arthroplasty Using a Visual Analogue Scale: A Single Surgeon Series. Archives of Orthopaedic and Trauma Surgery, 128, 255-259.
https://doi.org/10.1007/s00402-006-0272-9 |
| [6] | Glazebrook, M., Eid, M., Alhadhoud, M., et al. (2018) Percuta-neous Ankle Reconstruction of Lateral Ligaments. Foot and Ankle Clinics, 23, 581-592. https://doi.org/10.1016/j.fcl.2018.07.013 |
| [7] | Hua, Y., Chen, S., Jin, Y., et al. (2012) Anatomical Reconstruction of the Lateral Ligaments of the Ankle with Semitendinosus Allograft. International Orthopaedics, 36, 2027-2031. https://doi.org/10.1007/s00264-012-1577-7 |
| [8] | Youn, H., Kim, Y.S., Lee, J., et al. (2012) Percutaneous Lateral Ligament Reconstruction with Allograft for Chronic Lateral Ankle Instability. Foot & Ankle International, 33, 99-104. https://doi.org/10.3113/FAI.2012.0099 |
| [9] | Korkala, O., Sorvali, T., Niskanen, R., et al. (2002) Twenty-Year Results of the Evans Operation for Lateral Instability of the Ankle. Clinical Orthopaedics and Related Research, 405, 195-198.
https://doi.org/10.1097/00003086-200212000-00025 |
| [10] | Fujii, T., Kitaoka, H.B., Watanabe, K., et al. (2006) Comparison of Modified Brostr？m and Evans Procedures in Simulated Lateral Ankle Injury. Medicine & Science in Sports & Exercise, 38, 1025-1031.
https://doi.org/10.1249/01.mss.0000222827.56982.40 |
| [11] | Higashiyama, R., Sekiguchi, H., Takata, K., Katagiri, A., Inoue, G. and Takaso, M. (2020) Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon. Arthroscopy Techniques, 9, E21-E28.
https://doi.org/10.1016/j.eats.2019.08.009 |
| [12] | Malinowski, K., Paszkowski, J., Goralczyk, A., Giza, E. and Her-manowicz, K. (2020) Arthroscopic Anatomic Anterior Talofibular Ligament Repair for Anterolateral Ankle Instability. Arthroscopy Techniques, 9, E29-E33.
https://doi.org/10.1016/j.eats.2019.08.008 |
| [13] | Zeng, G., Hu, X., Liu, W., et al. (2020) Open Brostr？m-Gould Repair vs Arthroscopic Anatomical Repair of the Anterior Talofibular Ligament for Chronic Lateral Ankle Instability. Foot & Ankle International, 41, 44-49.
https://doi.org/10.1177/1071100719875964 |
| [14] | Li, H., Hua, Y., Li, H., Ma, K., Li, S. and Chen, S. (2017) Activ-ity Level and Function 2 Years After Anterior Talofibular Ligament Repair: A Comparison Between Arthroscopic Repair and Open Repair Procedures. The American Journal of Sports Medicine, 45, 2044-2051. https://doi.org/10.1177/0363546517698675 |
| [15] | Matsui, K., Takao, M., Miyamoto, W. and Matsushita, T. (2016) Early Recovery after Arthroscopic Repair Compared to Open Repair of the Anterior Talofibular Ligament for Lateral In-stability of the Ankle. Archives of Orthopaedic and Trauma Surgery, 136, 93-100. https://doi.org/10.1007/s00402-015-2342-3 |
| [16] | Li, H., Hua, Y., Li, H. and Chen, S. (2020) Anterior Talofibular Ligament (ATFL) Repair Using Two Suture Anchors Produced Better Functional Outcomes than Using One Suture Anchor for the Treatment of Chronic Lateral Ankle Instability. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 221-226. https://doi.org/10.1007/s00167-019-05550-y |
| [17] | Cottom, J.M., Baker, J.S. and Richardson, P.E. (2016) The “All-Inside” Arthroscopic Brostr？m Procedure with Additional Suture Anchor Augmentation: A Prospective Study of 45 Consecutive Patients. The Journal of Foot & Ankle Surgery, 55, 1223-1228. https://doi.org/10.1053/j.jfas.2016.07.023 |
| [18] | Batista, J.P., Vecchio, J.J., Patthauer, L., et al. (2017) Arthroscopic Lateral Ligament Repair through Two Portals in Chronic Ankle Instability. The Open Orthopaedics Journal, 11, 617-632.
https://doi.org/10.2174/1874325001711010617 |
| [19] | Lai, M.W.W. and Sit, R.W.S. (2018) Healing of Complete Tear of the Anterior Talofibular Ligament and Early Ankle Stabilization after Autologous Platelet Rich Plasma: A Case Report and Literature Review. Archives of Bone and Joint Surgery, 6, 146-149. |
