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改良 Broström 手术治疗慢性踝关节不稳定患者的肌肉耐力和姿势稳定性优于保守治疗。

Modified Broström procedure in patients with chronic ankle instability is superior to conservative treatment in terms of muscle endurance and postural stability.

机构信息

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.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):93-99. doi: 10.1007/s00167-019-05582-4. Epub 2019 Jun 22.


DOI:10.1007/s00167-019-05582-4
PMID:31230124
Abstract

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.

摘要

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。

相似文献

[1]
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[2]
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[7]
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引用本文的文献

[1]
Clinical Outcomes and Return to Preinjury Sports After Anatomic Reconstruction With a Gracilis Autograft Versus the Modified Broström Procedure in Patients With Generalized Joint Laxity.

Orthop J Sports Med. 2024-3-6

[2]
Insufficient recovery of proprioception in chronic ankle instability after surgical restabilization: A systematic review.

Asia Pac J Sports Med Arthrosc Rehabil Technol. 2023-12-21

[3]
Arthroscopic modified Broström procedure achieved similar favorable short term outcomes to open procedure for chronic lateral ankle instability cases with generalized joint laxity.

Knee Surg Sports Traumatol Arthrosc. 2023-9

[4]
Comparison of balance and function in the long term after all arthroscopic ATFL repair surgery.

Arch Orthop Trauma Surg. 2023-8

[5]
The Effects of Chronic Ankle Instability on the Biomechanics of the Uninjured, Contralateral Ankle During Gait.

Orthop Surg. 2022-9

[6]
Arthroscopic modified Broström procedure achieves faster return to sports than open procedure for chronic ankle instability.

Knee Surg Sports Traumatol Arthrosc. 2022-10

[7]
Proprioception and neuromuscular control at return to sport after ankle surgery with the modified Broström procedure.

Sci Rep. 2022-1-12

[8]
Reliability and usefulness of the single leg heel raise balance test in patients with chronic ankle instability.

Sci Rep. 2021-10-13

[9]
Static and Dynamic Quadriceps Stretching Exercises in Patients With Patellofemoral Pain: A Randomized Controlled Trial.

Sports Health. 2021

[10]
Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients.

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本文引用的文献

[1]
Individuals with recurrent ankle sprain demonstrate postural instability and neuromuscular control deficits in unaffected side.

Knee Surg Sports Traumatol Arthrosc. 2018-10-5

[2]
Surgical management of chronic lateral ankle instability: a meta-analysis.

J Orthop Surg Res. 2018-6-25

[3]
Comparative postural stability in patients with lateral meniscus versus medial meniscus tears.

Knee. 2018-3

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Periosteal flap augmentation of the Modified Broström-Gould procedure for chronic lateral ankle instability.

J Orthop Surg (Hong Kong). 2018

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Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert.

Knee Surg Sports Traumatol Arthrosc. 2017-4-25

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Clinical results of an arthroscopic modified Brostrom operation with and without an internal brace.

J Orthop Traumatol. 2016-12

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Early recovery after arthroscopic repair compared to open repair of the anterior talofibular ligament for lateral instability of the ankle.

Arch Orthop Trauma Surg. 2016-1

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Morphological study of mechanoreceptors in collateral ligaments of the ankle joint.

J Orthop Surg Res. 2015-6-12

[9]
The improvement of postural control in patients with mechanical ankle instability after lateral ankle ligaments reconstruction.

Knee Surg Sports Traumatol Arthrosc. 2016-4

[10]
Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy.

Orthop Traumatol Surg Res. 2013-11-20

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