Department of Sports Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):93-99. doi: 10.1007/s00167-019-05582-4. Epub 2019 Jun 22.
PURPOSE: To compare muscle strength, muscle endurance, and postural stability in both the affected and unaffected ankles between patients with chronic ankle instability (CAI) who underwent conservative treatment and those who underwent the modified Broström procedure (MBP). METHODS: A total of 67 patients (37, conservative treatment; 30, MBP) participated. Muscle strength and muscle endurance were measured using an isokinetic device, and postural stability was tested using a postural stabilometry system. We used the independent t test for continuous variables with a normal distribution and Fisher's exact test for categorical variables. RESULTS: There was no difference in the muscle strengths of the affected and unaffected ankles between the groups. The muscle endurance of plantarflexion and inversion muscles was significantly lower in the affected ankles of the conservative treatment group than in those of the MBP group (plantarflexion: 209 ± 103.1 vs. 318 ± 162.2, p = 0.001; inversion: 93 ± 58.7 vs. 154 ± 65.9, p < 0.001). Static postural stability testing showed no significant differences between the affected and unaffected ankles of the two groups. In the dynamic postural stability test, the overall, anterior-posterior, and medial-lateral stability indices were all significantly higher in the affected ankles of the conservative treatment group than in those of the MBP group (p < 0.001, p = 0.004, p = 0.004, respectively), with no differences observed in the unaffected ankles. CONCLUSION: The MBP may significantly improve muscle endurance and dynamic postural stability in CAI patients in whom conservative treatment has failed. Therefore, clinicians should consider using MBP instead of conservative treatment when patients show severe muscle weakness or dynamic postural instability. LEVEL OF EVIDENCE: Case-control study, Level III.
目的:比较保守治疗与改良 Broström 手术(MBP)治疗慢性踝关节不稳定(CAI)患者患侧和健侧踝关节的肌肉力量、肌肉耐力和姿势稳定性。
方法:共有 67 例患者(保守治疗 37 例,MBP 治疗 30 例)参与了本研究。使用等速测力仪测量肌肉力量和肌肉耐力,使用姿势稳定仪系统测试姿势稳定性。我们使用正态分布的独立 t 检验和分类变量的 Fisher 确切检验进行连续变量的比较。
结果:两组患者患侧和健侧踝关节的肌肉力量无差异。保守治疗组患侧踝关节的跖屈和内翻肌群肌肉耐力明显低于 MBP 组(跖屈:209±103.1 比 318±162.2,p=0.001;内翻:93±58.7 比 154±65.9,p<0.001)。静态姿势稳定性测试显示两组患者患侧和健侧踝关节之间无显著差异。在动态姿势稳定性测试中,保守治疗组患侧踝关节的整体、前后和内外稳定性指数均显著高于 MBP 组(p<0.001、p=0.004、p=0.004),而健侧踝关节无差异。
结论:对于保守治疗失败的 CAI 患者,MBP 可显著改善肌肉耐力和动态姿势稳定性。因此,当患者出现严重肌肉无力或动态姿势不稳定时,临床医生应考虑使用 MBP 替代保守治疗。
证据等级:病例对照研究,III 级。
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