不同方法治疗急性踝关节外侧副韧带损伤的疗效比较

摘要

目的：探讨不同治疗方式对急性踝关节外侧副韧带损伤患者足后段功能的影响。方法回顾性分析我院收治的131例急性踝关节外侧副韧带损伤的患者，将患者按照治疗方式不同分为保守治疗组（石膏固定）41例、手术直接修复组（锚钉修复）47例以及手术韧带重建组（改良 Elmslie手术方式）43例，利用美国足踝外科协会（American orthopaedic foot and ankle society，AOFAS）评分评估足后段功能，观察3组患者治疗前与治疗后12个月后 AOFAS评分、临床疗效、并发症情况。结果三组患者治疗后12个月的AOFAS评分总分较治疗前均有显著性升高（P＜0．05），手术直接修复组和韧带重建组患者的 AOFAS评分总分和临床疗效显著优于保守治疗组（P＜0．05），但两组手术治疗组患者的术后并发症发生率要高于保守治疗组，差异有统计学意义（P＜0．05），而手术直接修复组和韧带重建组的 AOFAS评分总分、临床疗效以及并发症发生率之间差异无统计学意义（P＞0．05）。结论手术治疗对急性踝关节外侧副韧带损伤患者足后段功能改善的效果较保守治疗明显，但安全性差，锚钉修复和改良 Elmslie的手术作用效果相当，因此应当依据综合情况确定治疗方案。%Objective To discuss the effect of different treatment methods on function of posterior segment of foot in patients with acute lateral collateral ligament injury of the ankle joint.Methods 131 cases of patients with acute lat-eral collateral ligament injury of the ankle joint were analyzed retrospectively.According to different treatment meth-ods,the patients were divided into conservative treatment group (plaster fixation),direct surgical repair group (anchor nail repair)and surgical ligament reconstruction group (modified Elmslie operation mode).The AOFAS score was used to evaluate the function of posterior segments of foot,and the scores of AOFAS before treatment and 1 2 months after treatment,clinical therapeutic effect and complications were compared among the three groups.Results The total AO-FAS scores after 1 2 months of treatment in the three groups were significantly increased compared with those before treatment (P<0.05),among which the total AOFAS score and clinical therapeutic effect in the direct surgical repair group and surgical ligament reconstruction group were significantly better than those in the conservative treatment group (P<0.05),but the incidence rates of complications in the two groups were higher than that in the conservative treatment group,and the differences were statistically significant (P<0.05 ).The differences in the total AOFAS scores,clinical therapeutic effect and incidence rates of complications between the direct surgical repair group and surgi-cal ligament reconstruction group were not statistically significant (P>0.05).Conclusion The improvement effect of operation method on the function of posterior segment of foot in patients with acute lateral collateral ligament inj ury of the ankle joint is more obviously than conservative treatment,but the safety is poor.And the effect of anchor nail repair is similar to the modified Elmslie operation,so the treatment plan should be determined based on the comprehensive situation.