Yeo Eui Dong, Lee Kyung-Tai, Sung Il-Hoon, Lee Sun Geun, Lee Young Koo
Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea.
Foot and Ankle Clinic, KT Lee's Orthopedic Hospital, Republic of Korea.
Foot Ankle Int. 2016 Oct;37(10):1037-1045. doi: 10.1177/1071100716666508. Epub 2016 Sep 13.
No reported study has compared clinical and radiologic outcomes between an all-inside arthroscopic modified Broström operation (MBO) and an open MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs.
From August 2012 to July 2014, 48 patients were included. They were divided into 2 groups: all-inside arthroscopic MBO (25 patients) and open MBO (23 patients). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. MBO was performed in 87 patients. Of these, 50 patients met the inclusion criteria. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Patients were randomized into 2 groups, all-inside arthroscopic MBO and open MBO, using a permuted block randomization method. Clinical outcome evaluations were performed preoperatively, at 6 weeks and 6 months postoperatively, and at a final follow-up at a minimum of 12 months postoperatively using the Karlsson score, the AOFAS ankle-hindfoot score, and pain VAS scores. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle.
After randomization, 25 ankles were allocated to the all-inside arthroscopic MBO group and 25 to the open MBO group. Two ankles in the open MBO group were excluded from the analysis because they were lost to follow-up. Thus, evaluations were performed for 25 ankles in the all-inside arthroscopic MBO group and 23 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P > .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups (P < .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P > .05).
There was no difference in the clinical or radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 1 year after surgery. An all-inside arthroscopic MBO should be considered carefully in patients who have lateral ankle instability.
Level I, randomized controlled trial.
尚无研究比较关节镜下全内置改良布罗斯特罗姆手术（MBO）与开放性MBO的临床及影像学结果。本研究旨在比较关节镜下全内置与开放性MBO的临床及影像学结果。
纳入2012年8月至2014年7月期间的48例患者。将其分为两组：关节镜下全内置MBO组（25例患者）和开放性MBO组（23例患者）。采用美国矫形足踝协会（AOFAS）踝-后足评分、视觉模拟量表（VAS）评分及卡尔森评分评估临床结果。采用距骨前移和距骨倾斜评估影像学结果。所有患者均有踝关节外侧不稳。87例患者接受了MBO手术。其中，50例患者符合纳入标准。所有患者均有打软腿、持续性疼痛且伤后6个月以上无法恢复伤前活动水平。采用置换区组随机化方法将患者随机分为两组，即关节镜下全内置MBO组和开放性MBO组。术前、术后6周和6个月以及术后至少12个月的最终随访时，使用卡尔森评分、AOFAS踝-后足评分和疼痛VAS评分进行临床结果评估。术前及术后1年最终随访时，采用距骨前移和距骨倾斜角进行影像学结果评估。
随机分组后，25例踝关节被分配至关节镜下全内置MBO组，25例被分配至开放性MBO组。开放性MBO组有2例踝关节因失访而被排除在分析之外。因此，对关节镜下全内置MBO组的25例踝关节和开放性MBO组的23例踝关节进行了评估。两组在年龄、性别、症状持续时间、术前AOFAS、VAS、卡尔森评分、距骨前移或距骨倾斜方面均无差异（所有P>.05）。在最终随访时，两组的AOFAS、VAS和卡尔森评分均有显著改善（P<.001）。最终随访时，两组在卡尔森、AOFAS或VAS评分、距骨前移或距骨倾斜方面均无差异（所有P>.05）。
对于踝关节外侧不稳的治疗，关节镜下全内置MBO与开放性MBO在术后长达1年的临床及影像学结果上无差异。对于有踝关节外侧不稳的患者，应谨慎考虑关节镜下全内置MBO。
I级，随机对照试验。
