【摘要】目的：探讨Brostrom手术结合关节镜对踝关节外侧不稳定合并踝关节内病变治疗的疗效。方法：2010 年12月至2014 年12月，本院采用Brostrom手术结合关节镜对踝关节外侧不稳定合并踝关节内病变的32例患者进行治疗，21例患者获得随访。采用AOFAS踝-后足评分评价术前，术后3个月、6个月、12个月及18个月的临床疗效。结果：术中通过踝关节镜发现19例（90.5%）患者有合并踝关节内病变，其中滑膜炎12例（63.2%）、软骨损伤6例（31.6%）、距骨骨赘形成4例（21.1%）、软组织嵌顿3例（15.8%）以及胫腓下联合分离1例（5%）；术前AOFAS评分为51.31±17.19，术后随访3个月评分为77.40±9.99，6个月评分91.55±6.91，12个月评分96.46±5.30，18个月评分97.15±3.08。结论： Brostrom手术结合关节镜对踝关节外侧不稳定合并踝关节内病变的治疗有良好的临床效果。
[Abstract]Objective To evaluate the surgical outcome of Brostrom procedure assisted with arthroscopic. Method This is a retrospective study involving 32 patients who underwent Brostrom procedure assisted with arthroscopic for lateral ankle instability at Tongji Hospital, 21 patient is completed follow-up from December 2010 to December 2014. The patients consisted of 16 males and 5 females with an average age of 23.5 years. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score was used to assess the pain and functional status in preoperative examination and postoperative follow-up at 3 months, 6 months，12 month and 18 months. Results Via Intra-operative ankle arthroscopic we found 19 patients associated with intra-articular lessions, presenting as synovitis in 12 cases，osteochondral lesion in 6 cases, osteophyte formation in 4 cases, soft tissue impingement in 3 cases, and syndesmosis widening in 1 case. The preoperative AOFAS score was 51.31±17.19. The AOFAS score for postoperative follow-up at 3 months was 77.40±9.99，6 months was 91.55±6.91, 12 months was 96.46±5.30, and 18 months was 97.15±3.08. Conclusion The Brostrom procedure assisted with ankle arthroscopic treatment for lateral ankle instability is a safe and effective method offering satisfying surgical outcome.
[1] Garrick JG. The frequency of injury,mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med.1977,5:241-242.
[2] Ng ZD, Das De S. Modified Brostrom-Evans-Gould technique for recurrent lateral ankle ligament instability. J Orthop Surg. 2007,15:306–310.
[3] 毛宾尧.踝关节不稳[J/CD].中华关节外科杂志：电子版，2009,3（1）:46 -48.
[4] 马骁，胡跃林. 手术治疗慢性踝关节外侧不稳106例[J].中华关节外科杂志：电子版，2012,5（1）:15-19.
[5] Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC. Management of ankle sprains[J]. AmFam physician, 2001, 63(1):93–104.
[6] Muijs SP，Dijkstra PD，Bos CF. Clinical outcome after anatomical reconstruction of the lateral ankle ligaments using the Duquennoy technique in chronic lateral instability of the ankle: a longterm follow-up study.[J] Bone Joint Surg. 2008,90(B):50–56.
[7] DiGiovanni BF,Partal G, Baumhauer JF. Acute ankle injury and chronic lateral instability in the athlete.Clinics in Sports Medicine 2004,23(1):1–19.
[8] DiGiovanni CW，Brodsky A. Current concepts: lateral ankle instability. Foot and Ankle International.2006,27(10):854–66.
[9] 陈钺.对两例踝关节损伤病理和病因及伤后处理的探讨[J].福建师大福清分校学报, 2011,31(5):65-69.
[10] 于涛, 俞光荣. 踝关节外侧不稳定的生物力学研究进展[J].中国骨与关节损伤杂志,2010,25(1):94-96.
[11] Takao M, Innami K, Matsushita T, et al. Arthroscopic and magnetic resonance image appearance and reconstruction of the anterior talofibular ligament in cases of apparent functional ankle instability. Am J Sports Med. 2008, 36 (8):1542–1547.
[12] Choi WJ, Lee JW, Han SH, et al. Chronic lateral ankle instability:the effect of intra-articular lesions on clinical outcome. Am J Sports Med. 2008,36(11):2167–2172.
[13] Ferkel RD, Chams RN. Chronic lateral instability: arthroscopic findings and long-term results. Foot Ankle Int. 2007(1), 28:24–31.
[14] Xu HX, Choi MS, Kim MS, Park KS, Lee KB. Gender Differences in Outcome After Modified Brostr?m Procedure for Chronic Lateral Ankle Instability. Foot Ankle Int. 2016 Jan,37(1):64-9.
