关节镜下关节囊收缩术治疗慢性外侧踝关节不稳
Arthroscopic Capsular Shrinkage for Treatment of Chronic Lateral Ankle Instability.
作者信息
Vuurberg Gwendolyn, de Vries Jasper S, Krips Rover, Blankevoort Leendert, Fievez Alex W F M, van Dijk C Niek
机构信息
1 Academic Medical Center, Department of Orthopedic Surgery, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
2 Academic Center for Evidence based Sports medicine (ACES), Amsterdam, the Netherlands.
出版信息
Foot Ankle Int. 2017 Oct;38(10):1078-1084. doi: 10.1177/1071100717718139. Epub 2017 Jul 26.
BACKGROUND
Capsular shrinkage is an arthroscopic stabilization technique that can be used in patients with chronic ankle instability (CAI), if desired in addition to primary arthroscopic procedures. Despite positive short-term results, long-term follow-up of these patients has not yet been performed. Therefore, our objective was to assess whether capsular shrinkage still provided functional outcome after 12-14 years compared to preoperative scores.
METHODS
This study was a retrospective long-term follow-up of a prospectively conducted longitudinal multicenter trial. The study duration was from February 2002 to September 2016, including a preoperative assessment and short-, mid-, and long-term follow-up. At the time of inclusion, patients were diagnosed with CAI, >18 years old, were unresponsive to conservative treatment, and had confirmed mechanical ankle joint laxity. Patients were excluded if the talar tilt was greater than 15 degrees, if they had received previous operative treatment, or had constitutional hyperlaxity, systemic diseases, or osteoarthritis grade II or III. The primary outcome was the change in functional outcome as assessed by the Karlsson score.
RESULTS
Twenty-five patients of the initial 39 were available for this follow-up. This group had a mean age of 43.2 years (SD±11.1) and included 15 males. A statistically significant improvement was found in the Karlsson score at 12-14 years (76.6 points; SD±25.5) relative to the preoperative status (56.4 points; SD ±13.3; P < .0005). Although 17 patients (68%) reported recurrent sprains, 23 patients (92%) stated that they were satisfied with the procedure.
CONCLUSIONS
Despite improved functional outcome and good satisfaction in patients with CAI after capsular shrinkage, recurrence rates and residual symptoms were high. For this reason, arthroscopic capsular shrinkage is not recommended as joint stabilization procedure in patients with CAI.
LEVEL OF EVIDENCE
Level IV, case series.
背景
关节囊收缩术是一种关节镜下稳定技术，若需要，可在初次关节镜手术之外用于慢性踝关节不稳（CAI）患者。尽管短期效果良好，但尚未对这些患者进行长期随访。因此，我们的目的是评估与术前评分相比，12至14年后关节囊收缩术是否仍能提供功能结果。
方法
本研究是对一项前瞻性纵向多中心试验的回顾性长期随访。研究时间为2002年2月至2016年9月，包括术前评估以及短期、中期和长期随访。纳入时，患者被诊断为CAI，年龄大于18岁，对保守治疗无反应，且踝关节存在明确的机械性松弛。如果距骨倾斜大于15度、曾接受过手术治疗、存在先天性关节过度松弛、全身性疾病或II级或III级骨关节炎，则排除这些患者。主要结局是通过卡尔森评分评估的功能结果变化。
结果
最初的39例患者中有25例可用于此次随访。该组患者的平均年龄为43.2岁（标准差±11.1），包括15名男性。相对于术前状态（56.4分；标准差±13.3），在12至14年时卡尔森评分有统计学意义的改善（76.6分；标准差±25.5；P <.0005）。尽管17例患者（68%）报告有复发性扭伤，但23例患者（92%）表示对该手术满意。
结论
尽管关节囊收缩术后CAI患者的功能结果有所改善且满意度较高，但复发率和残留症状较高。因此，不建议将关节镜下关节囊收缩术作为CAI患者的关节稳定手术。
证据级别
IV级，病例系列。
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