Comparison of modified Brostrom and Evans procedures in simulated lateral ankle injury
Comparison of modified Brostrom and Evans procedures in simulated lateral ankle injury
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DOI：
10.1249/01.mss.0000222827.56982.40
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发表时间：
2006-06-01
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影响因子：
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通讯作者：
An, Kai-Nan
中科院分区：
文献类型：
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作者：
Fujii, Tadashi;Kitaoka, Harold B.;An, Kai-Nan
目的：本研究的目的是比较改良的Brostrom和Evans两种术式在模拟身体小腿外侧踝关节不稳中的作用。方法：对6例正常身体踝关节在屈踝范围内施加内翻和内旋应力，测量跟骨和距骨相对于胫骨的三维运动。使用了脚踝稳定性测试装置和磁力跟踪系统。在切断距腓前韧带(ATFL)和跟腓韧带(CFL)后，在Brostrom手术Gould改良后和Evans手术后，在完整状态和不稳定状态下进行测试。结果：在翻转载荷作用下，两种术式的踝关节-后足复合体(跟骨-胫骨)的稳定性明显高于不稳定状态，但Evans手术后从中立位到足屈位的运动受限。两次手术后胫距内翻运动均接近正常，但Evans手术在整个踝关节屈曲范围内距下运动明显受限。在内旋负荷下，Brostrom手术使踝关节-后足关节复合体在屈足时稳定。埃文斯手术改善了内旋转稳定性，但限制了所有位置的运动。两种手术均提高了胫距内旋转稳定性，但均未恢复正常。Brostrom手术后距下内旋转与正常情况相同，Evans手术后踝关节屈曲范围明显受限。结论：两种手术都改善了踝-后足的稳定性，但都不能成功地将其恢复到踝关节稳定性测试仪所确定的正常状态。Evans手术改善了稳定性，但造成距下功能异常。Brostrom手术在没有过度限制距下运动的情况下改善了稳定性，但在解决内旋转松弛方面效果不佳。
Purpose: The purpose of this study was to compare the modified Brostrom and Evans procedures for simulated lateral ankle instability in cadaveric lower extremities. Methods: Six normal cadaveric ankles were loaded with inversion and internal rotation stress through the range of ankle flexion, and three-dimensional motion of the calcaneus and talus relative to the tibia were measured. An ankle stability testing device and a magnetic tracking system were used. Testing was performed in the intact condition, unstable condition after sectioning both the anterior talofibular (ATFL) and calcaneofibular ligaments (CFL), after the Gould modification of the Brostrom procedure, and after the Evans procedure. Results: With inversion loading, both operations resulted in a significantly more stable ankle-hindfoot complex (calcaneal-tibial) than the unstable condition, but there was restricted motion after the Evans operation from neutral to plantarflexion. Tibiotalar inversion motion approximated normal after both operations, but subtalar motion was markedly restricted in the Evans procedure throughout the range of ankle flexion. With internal rotation loading, the Brostrom operation stabilized the ankle-hindfoot joint complex in plantarflexion. The Evans operation improved internal rotation stability, but restricted motion in all positions. Both operations improved tibiotalar internal rotation stability, but not to normal. The subtalar internal rotation was the same as the intact condition after the Brostrom operation, but markedly restricted after the Evans operation through the range of ankle flexion. Conclusions: Both operations improved ankle-hindfoot stability, but neither was successful in restoring it to normal as determined with the ankle stability testing device. The Evans procedure improved stability at the expense of creating abnormal subtalar function. The Brostrom operation improved stability without excessively restricting subtalar movement, but was not effective in addressing the internal rotation laxity.