外側(cè)副韌帶修復(fù)聯(lián)合關(guān)節(jié)鏡下踝關(guān)節(jié)清理治療慢性踝關(guān)節(jié)不穩(wěn)的臨床療效研究
發(fā)布時(shí)間：2018-07-21 20:23
【摘要】：背景:踝關(guān)節(jié)扭傷為骨科門急診中較為常見的疾病,約90%會(huì)累及外側(cè)副韌帶,約70%—85%的踝關(guān)節(jié)扭傷經(jīng)急診處理及功能鍛煉后可獲得良好的療效,但臨床上由于對(duì)急性踝關(guān)節(jié)扭傷的認(rèn)識(shí)不足、治療不當(dāng),約有20%的急性踝關(guān)節(jié)扭傷患者會(huì)發(fā)展為慢性踝關(guān)節(jié)不穩(wěn),且常合并關(guān)節(jié)內(nèi)的各種病變,如關(guān)節(jié)內(nèi)軟骨損傷、骨性撞擊、關(guān)節(jié)內(nèi)游離體形成等,加重踝關(guān)節(jié)功能障礙。慢性踝關(guān)節(jié)外側(cè)不穩(wěn)的發(fā)病原因與患者既往有反復(fù)的踝關(guān)節(jié)扭傷史、關(guān)節(jié)內(nèi)各種病變、足部畸形等多種因素有關(guān),臨床表現(xiàn)主要有關(guān)節(jié)不穩(wěn)感、慢性疼痛及踝關(guān)節(jié)本體感覺受損等。慢性外側(cè)踝關(guān)節(jié)不穩(wěn)主要分為機(jī)械性不穩(wěn)和功能性不穩(wěn),目前功能性不穩(wěn)主要選擇保守治療,部分機(jī)械性不穩(wěn)可行手術(shù)治療。手術(shù)治療主要分為三大類,一類為解剖修復(fù):主要包括Brostrom法及改良的Brostrom法;一類為解剖重建:運(yùn)用自體或異體肌腱重建外側(cè)副韌帶;另一類為非解剖重建術(shù):主要包括Watson-Jones術(shù)、Evans術(shù)及Chrisman-Snook術(shù)。以上各手術(shù)中解剖修復(fù)盡可能的恢復(fù)了外側(cè)踝關(guān)節(jié)的生物力學(xué)穩(wěn)定性,具有較好的機(jī)械限制作用、手術(shù)時(shí)間短、保留了大量的踝關(guān)節(jié)周圍本體感受器,術(shù)后并發(fā)癥較少、踝關(guān)節(jié)功能恢復(fù)良好,被廣泛用于外側(cè)副韌帶的修復(fù)。無論哪種手術(shù)方式,若對(duì)于合并關(guān)節(jié)內(nèi)病變的患者僅行韌帶修復(fù)而未處理關(guān)節(jié)內(nèi)的病變會(huì)大大降低術(shù)后療效,因此在行手術(shù)修復(fù)外側(cè)副韌帶的同時(shí)處理關(guān)節(jié)內(nèi)的病變尤為重要。本文將踝關(guān)節(jié)腔清理與外側(cè)副韌帶修復(fù)兩種手術(shù)方式聯(lián)合即處理了關(guān)節(jié)內(nèi)的病變,又修復(fù)了外側(cè)副韌帶可更好的治療慢性外側(cè)踝關(guān)節(jié)不穩(wěn),通過觀察患者術(shù)后不同階段的踝關(guān)節(jié)功能評(píng)分以評(píng)估手術(shù)療效。目的:外側(cè)副韌帶修復(fù)結(jié)合踝關(guān)節(jié)鏡下關(guān)節(jié)腔清理處理關(guān)節(jié)內(nèi)病變治療慢性踝關(guān)節(jié)不穩(wěn)的臨床療效。方法:選取安徽醫(yī)科大學(xué)第一附屬醫(yī)院骨外科2012年10月至2014年10月診治的28例慢性踝關(guān)節(jié)不穩(wěn)患者,所有患者均行踝關(guān)節(jié)鏡處理關(guān)節(jié)內(nèi)病變后修復(fù)外側(cè)副韌帶,分別于術(shù)前、術(shù)后3個(gè)月、6個(gè)月、1年應(yīng)用AOFAS踝-后足功能評(píng)分系統(tǒng)對(duì)各患者進(jìn)行踝關(guān)節(jié)功能評(píng)分。結(jié)果:所有患者術(shù)后隨訪1年,AOFAS術(shù)前評(píng)分為(40.63±4.75)分,術(shù)后3個(gè)月評(píng)分為(68.75±3.65)分,6個(gè)月評(píng)分為(90.00±1.31)分,1年評(píng)分為(91.25±1.28)分,術(shù)后踝關(guān)節(jié)功能評(píng)分明顯高于術(shù)前,有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論:外側(cè)副韌帶修復(fù)結(jié)合踝關(guān)節(jié)腔清理是治療慢性外側(cè)踝關(guān)節(jié)不穩(wěn)的有效方法,通過踝關(guān)節(jié)鏡技術(shù)可有效的處理關(guān)節(jié)內(nèi)增生的滑膜、游離體、軟骨損傷等關(guān)節(jié)內(nèi)病變,此種聯(lián)合手術(shù)可顯著提高踝關(guān)節(jié)功能,有效緩解踝關(guān)節(jié)疼痛及延緩踝關(guān)節(jié)癥狀進(jìn)一步惡化。外側(cè)副韌帶修復(fù)結(jié)合踝關(guān)節(jié)鏡下關(guān)節(jié)腔清理處理關(guān)節(jié)內(nèi)病變治療慢性踝關(guān)節(jié)不穩(wěn)具有良好的臨床療效。
[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 鹵4.75), (68.75 鹵3.65), (90.00 鹵1.31) and (91.25 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4
本文編號(hào)：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 鹵4.75), (68.75 鹵3.65), (90.00 鹵1.31) and (91.25 鹵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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
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年08期
3 李光憲,陳學(xué)敏,季永東,李其水,郭延章;踝關(guān)節(jié)損傷后不穩(wěn)定的手術(shù)重建[J];中國(guó)修復(fù)重建外科雜志;2003年06期
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