关节镜下缝合锚钉修复外侧踝关节韧带复合体。
Arthroscopic repair of lateral ankle ligament complex by suture anchor.
机构信息
Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
出版信息
Arthroscopy. 2014 Jun;30(6):766-73. doi: 10.1016/j.arthro.2014.02.023. Epub 2014 Mar 27.
PURPOSE
Arthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique.
METHODS
We performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score.
RESULTS
After reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases.
CONCLUSIONS
Studies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV studies.
目的
关节镜下使用缝合锚修复外侧韧带复合体越来越多地用于治疗慢性踝关节不稳定（CAI）。我们的目的是（1）分析和评估关节镜下前距腓韧带缝合锚修复的文献，（2）对该技术治疗 CAI 的报告结果和并发症的临床证据进行系统回顾。
方法
我们使用 PubMed、Ovid、Elsevier ScienceDirect、Web of Science-Conference Proceedings Citation Index 和 Cochrane 系统评价数据库，从 1987 年至 2013 年 9 月对文献进行了系统回顾。纳入使用关节镜下缝合锚技术治疗 CAI 的临床研究。观察指标包括术后韧带稳定性和并发症的临床评估。此外，还使用改良 Coleman 方法评分评估纳入研究的方法学质量。
结果
在对 371 项研究进行审查后，我们确定了 6 项符合纳入标准的研究（5 项回顾性病例系列研究和 1 项前瞻性病例系列研究，均为 IV 级），平均 Coleman 方法评分 71.8±7.52（范围，63-82）。这些研究中有 178 例患者（179 个踝关节）接受了前距腓韧带关节镜下缝合锚修复，平均随访时间为 38.9 个月（范围，6-117.6 个月）。所有患者均报告踝关节不稳定的主观改善，31 例出现并发症。
结论
关节镜下缝合锚技术治疗 CAI 的研究较少，方法学质量中等。纳入的研究表明，该关节镜技术是一种可行的恢复踝关节稳定性的方法；然而，基于我们的综述，该技术似乎与相对较高的并发症发生率相关。未来应进行广泛的尸体研究、临床试验和比较关节镜和开放修复的研究。
证据等级
IV 级，IV 级研究的系统评价。
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