Li Q R, Hu Y W, Tao H Y, Xue X A, Hua Y H
Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China.
Zhonghua Yi Xue Za Zhi. 2023 Mar 21;103(11):803-808. doi: 10.3760/cma.j.cn112137-20220824-01797.
To explore whether the combination of anterior bony impingement before surgery will affect the efficacy of the lateral collateral ankle ligament reconstruction surgery in patients with chronic ankle instability (CAI). A prospective cohort study. Patients with CAI who underwent lateral collateral ankle ligament reconstruction from January 2014 to October 2017 in the Department of Sports Medicine, Huashan Hospital, Fudan University were enrolled in this study. The patients were divided into no bony impingement group (NI group) and bony impingement group (BI group) according to the presence of bone impingement in front of the ankle during the operation. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson ankle functional socre (KAFS), Tegner score, visual analogue scale (VAS) of pain were extracted and were reevaluated at least 2 years after surgery as well as imaging evaluation of ankle. A total of 59 patients were enrolled in this study. There were 29 patients in the NI group, 23 males and 6 females with a mean age of (28.4±7.1) years. And there were 30 cases in the BI group, 28 males and 2 females with a mean age of (31.9±8.6) years. The AOFAS, KAFS and Tegner scores in NI group increased from 65.8±10.6, 65.9±10.1 and 3.0 (3.0, 4.0) before the operation to 97.5±4.3, 97.8±4.7 and 6.0(5.0,6.0) after the operation, respectively; and the VAS decreased from 3.0(3.0, 4.0) to 0(0, 0); there were significant differences in those indexes before and after the operation (all <0.05). The scores of AOFAS, KAFS and Tegner in BI group increased from 65.2±11.0, 64.2±10.0 and 3.0(3.0, 4.0) before the operation to 97.1±4.3, 97.3±4.3 and 5.0(4.0, 6.0) post the operation, respectively; and the VAS scores decreased from 3.0(3.0, 5.0) to 0(0, 1.0); there were significant differences in up-mentioned indexes before and after the surgery (all <0.05). There was no significant differences in baseline and preoperative clinical function scores between the two groups (all >0.05). No significant difference was found in postoperative AOFAS, KAFS and VAS scores between the two groups (all >0.05), while postoperative Tegner score in the NI group was significantly higher than that in the BI group [6.0(5.0, 6.0) vs 5.0(4.0, 6.0), =0.026]. Imaging evaluation of all patients showed that the reconstructed ligament was clearly visible, and the intraarticular injuries existing before surgery showed obvious signs of healing. Ankle lateral collateral ligament reconstruction for CAI with or without anterior bony impingement results in similar outcomes in ankle function, stability and pain levels.
探讨术前合并前侧骨质撞击是否会影响慢性踝关节不稳（CAI）患者行外侧副韧带重建手术的疗效。一项前瞻性队列研究。选取2014年1月至2017年10月在复旦大学附属华山医院运动医学科行外侧副韧带重建的CAI患者纳入本研究。根据术中踝关节前方是否存在骨质撞击将患者分为无骨质撞击组（NI组）和骨质撞击组（BI组）。提取术前美国矫形足踝协会（AOFAS）评分、卡尔森踝关节功能评分（KAFS）、特格纳评分、疼痛视觉模拟量表（VAS），并在术后至少2年进行重新评估，同时对踝关节进行影像学评估。本研究共纳入59例患者。NI组29例，男23例，女6例，平均年龄（28.4±7.1）岁。BI组30例，男28例，女2例，平均年龄（31.9±8.6）岁。NI组术前AOFAS、KAFS和特格纳评分分别为65.8±10.6、65.9±10.1和3.0（3.0，4.0），术后分别为（97.5±4.3）、（97.8±4.7）和6.0（5.0，6.0）；VAS评分从3.0（3.0，4.0）降至0（0，0）；手术前后这些指标差异均有统计学意义（均P<0.05）。BI组术前AOFAS、KAFS和特格纳评分分别为65.2±11.0、64.2±10.0和3.0（3.0，4.0），术后分别为97.1±4.3、97.3±4.3和5.0（4.0，6.0）；VAS评分从3.0（3.0，5.0）降至0（0，1.0）；上述手术前后指标差异均有统计学意义（均P<0.05）。两组基线及术前临床功能评分差异均无统计学意义（均P>0.05）。两组术后AOFAS、KAFS和VAS评分差异均无统计学意义（均P>0.05），而NI组术后特格纳评分显著高于BI组[6.0（5.0，6.0）比5.0（4.0，6.0），P=0.026]。所有患者影像学评估显示重建韧带清晰可见，术前存在的关节内损伤有明显愈合迹象。对于CAI患者，行或不行前侧骨质撞击的踝关节外侧副韧带重建在踝关节功能、稳定性和疼痛程度方面的结果相似。
