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关节镜下滑膜切除术治疗功能性踝关节不稳:疗效及步态分析

Arthroscopic synovectomy in the treatment of functional ankle instability: outcomes and gait analysis.

作者信息

Altan Egemen, Ozbaydar Mehmet Ugur, Tonbul Murat, Şenaran Hakan, Temelli Yener, Akalan Ekin

机构信息

Orthopaedics and Traumatology Department, Medical Faculty, Medical School of Selcuk University, Konya, Turkey,

出版信息

Eur J Orthop Surg Traumatol. 2015 Jan;25(1):189-97. doi: 10.1007/s00590-014-1444-x. Epub 2014 Mar 28.

Abstract

BACKGROUND

Natural consequence of repetitive ankle sprains is the chronic ankle instability. Objective of this study was to clarify the gait patterns of functional ankle instability (FAI) patients after arthroscopic synovectomy, but also assessment of postoperative recovery.

PATIENTS AND METHODS

Arthroscopic synovectomy was performed to 14 FAI patients with history of unilateral repetitive ankle sprains, pain, and subjective sensation of instability. At a mean 54 months of follow-up (27-84), clinical assessment was conducted with respect to pain, number of ankle sprains, and American Orthopaedics Foot and Ankle Society (AOFAS) scores. Gait analysis was conducted to determine the temporospatial, kinetic and kinematic parameters at the last follow-up.

RESULTS

Mean AOFAS scores increased from 68 (range 55-75) to 89 (range 77-100) points (P < 0.01). Mean ankle sprains was 13 in a period of 23 (range 14-48) months (0.58 per month) and decreased to three sprains in a mean time period of 54 months (0.053 per month) (P < 0.01). Mean preoperative and postoperative VAS scores were 8.0 and 2.9, respectively (P < 0.01). During gait analysis, no significant differences were found in ankle joint, including foot progression angles, ankle dorsi-plantar flexion degrees and ground reaction forces (P > 0.01). Among temporospatial parameters, only double support time showed a significant difference (P < 0.01). All patients were satisfied from the procedure and returned to their previous activity level.

CONCLUSION

Improved long-term clinical results and scores were obtained in our patient group when compared with the preoperative scores. Also, three-dimensional gait analysis showed that the involved ankles demonstrate similar gait patterns to the uninvolved ankles in patients with FAI.

摘要

背景

反复踝关节扭伤的自然结果是慢性踝关节不稳。本研究的目的是阐明关节镜下滑膜切除术后功能性踝关节不稳(FAI)患者的步态模式,并评估术后恢复情况。

患者与方法

对14例有单侧反复踝关节扭伤病史、疼痛及主观不稳感的FAI患者进行了关节镜下滑膜切除术。在平均54个月的随访期(27 - 84个月)内,针对疼痛、踝关节扭伤次数及美国矫形足踝协会(AOFAS)评分进行了临床评估。在最后一次随访时进行步态分析以确定时空、动力学和运动学参数。

结果

AOFAS平均评分从68分(范围55 - 75分)提高到89分(范围77 - 100分)(P < 0.01)。在23个月(范围14 - 48个月)内平均踝关节扭伤13次(每月0.58次),在平均54个月时减少至3次扭伤(每月0.053次)(P < 0.01)。术前和术后VAS平均评分分别为8.0和2.9(P < 0.01)。在步态分析中,踝关节各参数未见显著差异,包括足前进角、踝关节背伸 - 跖屈角度及地面反作用力(P > 0.01)。在时空参数中,仅双支撑时间有显著差异(P < 0.01)。所有患者对手术满意并恢复到术前活动水平。

结论

与术前评分相比,我们的患者组获得了改善的长期临床结果和评分。此外,三维步态分析显示,FAI患者患侧踝关节与未患侧踝关节表现出相似的步态模式。

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