外侧副韧带修复联合关节镜下踝关节清理治疗慢性踝关节不稳的临床疗效研究
发布时间：2018-07-21 20:23
【摘要】：背景:踝关节扭伤为骨科门急诊中较为常见的疾病,约90%会累及外侧副韧带,约70%—85%的踝关节扭伤经急诊处理及功能锻炼后可获得良好的疗效,但临床上由于对急性踝关节扭伤的认识不足、治疗不当,约有20%的急性踝关节扭伤患者会发展为慢性踝关节不稳,且常合并关节内的各种病变,如关节内软骨损伤、骨性撞击、关节内游离体形成等,加重踝关节功能障碍。慢性踝关节外侧不稳的发病原因与患者既往有反复的踝关节扭伤史、关节内各种病变、足部畸形等多种因素有关,临床表现主要有关节不稳感、慢性疼痛及踝关节本体感觉受损等。慢性外侧踝关节不稳主要分为机械性不稳和功能性不稳,目前功能性不稳主要选择保守治疗,部分机械性不稳可行手术治疗。手术治疗主要分为三大类,一类为解剖修复:主要包括Brostrom法及改良的Brostrom法;一类为解剖重建:运用自体或异体肌腱重建外侧副韧带;另一类为非解剖重建术:主要包括Watson-Jones术、Evans术及Chrisman-Snook术。以上各手术中解剖修复尽可能的恢复了外侧踝关节的生物力学稳定性,具有较好的机械限制作用、手术时间短、保留了大量的踝关节周围本体感受器,术后并发症较少、踝关节功能恢复良好,被广泛用于外侧副韧带的修复。无论哪种手术方式,若对于合并关节内病变的患者仅行韧带修复而未处理关节内的病变会大大降低术后疗效,因此在行手术修复外侧副韧带的同时处理关节内的病变尤为重要。本文将踝关节腔清理与外侧副韧带修复两种手术方式联合即处理了关节内的病变,又修复了外侧副韧带可更好的治疗慢性外侧踝关节不稳,通过观察患者术后不同阶段的踝关节功能评分以评估手术疗效。目的:外侧副韧带修复结合踝关节镜下关节腔清理处理关节内病变治疗慢性踝关节不稳的临床疗效。方法:选取安徽医科大学第一附属医院骨外科2012年10月至2014年10月诊治的28例慢性踝关节不稳患者,所有患者均行踝关节镜处理关节内病变后修复外侧副韧带,分别于术前、术后3个月、6个月、1年应用AOFAS踝-后足功能评分系统对各患者进行踝关节功能评分。结果:所有患者术后随访1年,AOFAS术前评分为(40.63±4.75)分,术后3个月评分为(68.75±3.65)分,6个月评分为(90.00±1.31)分,1年评分为(91.25±1.28)分,术后踝关节功能评分明显高于术前,有统计学意义(P0.001)。结论:外侧副韧带修复结合踝关节腔清理是治疗慢性外侧踝关节不稳的有效方法,通过踝关节镜技术可有效的处理关节内增生的滑膜、游离体、软骨损伤等关节内病变,此种联合手术可显著提高踝关节功能,有效缓解踝关节疼痛及延缓踝关节症状进一步恶化。外侧副韧带修复结合踝关节镜下关节腔清理处理关节内病变治疗慢性踝关节不稳具有良好的临床疗效。
[Abstract]:Background: ankle sprain is a common disease in orthopedic outpatient and emergency department. About 90% of ankle sprain involves lateral collateral ligament. About 70% to 85% of ankle sprain can get good curative effect after emergency treatment and functional exercise. However, due to the lack of understanding and improper treatment of acute ankle sprain, about 20% of patients with acute ankle sprain develop chronic ankle instability and are often associated with various intraarticular lesions, such as intra-articular cartilage injury and bone impact. The formation of the free body in the joint aggravated the dysfunction of the ankle joint. The causes of chronic lateral ankle instability are related to the past history of ankle sprain, various intraarticular lesions, foot deformities and other factors. Chronic pain and ankle proprioception damage. Chronic lateral ankle instability is mainly divided into mechanical instability and functional instability. The surgical treatment can be divided into three categories: one is anatomical repair, one is the Brostrom method and the modified Brostrom method, the other is anatomical reconstruction: the lateral collateral ligament is reconstructed with autogenous or allogeneic tendons. The other is non-anatomic reconstruction: Watson-Jones technique and Chrisman-Snook procedure. The anatomical repair can restore the biomechanical stability of the lateral ankle as much as possible, have better mechanical limitation, short operation time, retain a large number of proprioceptors around the ankle joint, and have less postoperative complications. The ankle function recovered well and was widely used in the repair of lateral collateral ligament. Either way, if the patients with intraarticular diseases are treated with ligamentous repair but not with intra-articular lesions, the postoperative efficacy will be greatly reduced. Therefore, it is very important to treat the joint lesions while repairing the lateral collateral ligaments. In this paper, we combined the ankle cavity debridement with the lateral collateral ligament repair to treat the lesions in the joint and the lateral collateral ligament to treat the chronic lateral ankle instability. The effect of operation was evaluated by observing the functional score of ankle joint at different stages after operation. Objective: to treat chronic ankle instability with lateral collateral ligament repair and arthroscopic debridement. Methods: Twenty-eight patients with chronic ankle instability were treated in the first affiliated Hospital of Anhui Medical University from October 2012 to October 2014. All the patients were treated with ankle arthroscopy to repair the lateral collateral ligament. Three months, six months and one year after operation, the patients were evaluated with AOFAS ankle-hind foot function scoring system. Results: the AOFAS scores were (40.63 卤4.75), (68.75 卤3.65), (90.00 卤1.31) and (91.25 卤1.28), respectively. The scores of ankle function after operation were significantly higher than those before operation (P 0.001). Conclusion: the repair of lateral collateral ligament combined with ankle cavity cleaning is an effective method for the treatment of chronic lateral ankle instability. Arthroscopic techniques can be used to effectively deal with intraarticular lesions such as synovium, free body, cartilage injury and so on. This combined operation can significantly improve ankle function, relieve ankle pain and delay the further deterioration of ankle symptoms. Treatment of chronic ankle instability with lateral collateral ligament repair combined with arthroscopic debridement of intraarticular lesions.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
本文编号：2136751
[Abstract]:Background: ankle sprain is a common disease in orthopedic outpatient and emergency department. About 90% of ankle sprain involves lateral collateral ligament. About 70% to 85% of ankle sprain can get good curative effect after emergency treatment and functional exercise. However, due to the lack of understanding and improper treatment of acute ankle sprain, about 20% of patients with acute ankle sprain develop chronic ankle instability and are often associated with various intraarticular lesions, such as intra-articular cartilage injury and bone impact. The formation of the free body in the joint aggravated the dysfunction of the ankle joint. The causes of chronic lateral ankle instability are related to the past history of ankle sprain, various intraarticular lesions, foot deformities and other factors. Chronic pain and ankle proprioception damage. Chronic lateral ankle instability is mainly divided into mechanical instability and functional instability. The surgical treatment can be divided into three categories: one is anatomical repair, one is the Brostrom method and the modified Brostrom method, the other is anatomical reconstruction: the lateral collateral ligament is reconstructed with autogenous or allogeneic tendons. The other is non-anatomic reconstruction: Watson-Jones technique and Chrisman-Snook procedure. The anatomical repair can restore the biomechanical stability of the lateral ankle as much as possible, have better mechanical limitation, short operation time, retain a large number of proprioceptors around the ankle joint, and have less postoperative complications. The ankle function recovered well and was widely used in the repair of lateral collateral ligament. Either way, if the patients with intraarticular diseases are treated with ligamentous repair but not with intra-articular lesions, the postoperative efficacy will be greatly reduced. Therefore, it is very important to treat the joint lesions while repairing the lateral collateral ligaments. In this paper, we combined the ankle cavity debridement with the lateral collateral ligament repair to treat the lesions in the joint and the lateral collateral ligament to treat the chronic lateral ankle instability. The effect of operation was evaluated by observing the functional score of ankle joint at different stages after operation. Objective: to treat chronic ankle instability with lateral collateral ligament repair and arthroscopic debridement. Methods: Twenty-eight patients with chronic ankle instability were treated in the first affiliated Hospital of Anhui Medical University from October 2012 to October 2014. All the patients were treated with ankle arthroscopy to repair the lateral collateral ligament. Three months, six months and one year after operation, the patients were evaluated with AOFAS ankle-hind foot function scoring system. Results: the AOFAS scores were (40.63 卤4.75), (68.75 卤3.65), (90.00 卤1.31) and (91.25 卤1.28), respectively. The scores of ankle function after operation were significantly higher than those before operation (P 0.001). Conclusion: the repair of lateral collateral ligament combined with ankle cavity cleaning is an effective method for the treatment of chronic lateral ankle instability. Arthroscopic techniques can be used to effectively deal with intraarticular lesions such as synovium, free body, cartilage injury and so on. This combined operation can significantly improve ankle function, relieve ankle pain and delay the further deterioration of ankle symptoms. Treatment of chronic ankle instability with lateral collateral ligament repair combined with arthroscopic debridement of intraarticular lesions.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
【参考文献】
相关期刊论文 前3条
1 Brendan J Mc Criskin;Kenneth L Cameron;Justin D Orr;Brian R Waterman;;Management and prevention of acute and chronic lateral ankle instability in athletic patient populations[J];World Journal of Orthopedics;2015年02期
2 唐康来;;注重慢性踝关节不稳的诊断和治疗[J];中国骨伤;2012年08期
3 李光宪,陈学敏,季永东,李其水,郭延章;踝关节损伤后不稳定的手术重建[J];中国修复重建外科杂志;2003年06期
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