Treatment of chronic ankle instability in children with ligament reinforcement and preservation of a large subfibular bone
10.3760/cma.j.cn115530-20221124-00602
- VernacularTitle:大腓骨下骨保留联合韧带加强修复治疗儿童慢性踝关节不稳定的疗效分析
- Author:
Xiaowei WANG
1
;
Xiaoming WANG
;
Bohai QI
;
Yunfeng LI
;
Yating YANG
;
Qiang JIE
Author Information
1. 西安交通大学附属红会医院儿童骨病医院，西安 710054
- Keywords:
Ankle joint;
Lateral ligament;
Joint instability;
Growth and development
- From:
Chinese Journal of Orthopaedic Trauma
2023;25(10):840-846
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of preserving a large subfibular bone and ligament reinforcement to treat chronic ankle instability in children.Methods:A retrospective study was conducted to analyze the clinical data of qualified 43 children with chronic ankle instability and a large subfibular bone (the maximum diameter greater than 8 mm) who had been treated at Children's Osteopathy Hospital, Honghui Hospital, Xi'an Jiaotong University from May 2019 to February 2022. There were 29 boys and 14 girls with an age of (9.5±1.2) years. According to treatment methods, they were divided into group A (19 cases) where the subfibular bone was excised and the ligaments were reinforced and group B (24 cases) where the subfibular bone was preserved and the ligaments were reinforced. The talar anterior displacement and talar inclination angle at preoperation and immediate postoperation, and the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) at preoperation and the last follow-up were recorded in both groups to make comparisons between the 2 groups and between preoperation and postoperation. Wound healing and complications were also recorded.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). All patients were followed up for (11.6±5.8) months. In all patients, the talar anterior displacement and talar inclination angle at immediate postoperation were significantly improved compared with the preoperation, and the ankle-hindfoot AOFAS score and VAS at the last follow-up also significantly improved compared with the preoperation ( P<0.05). The talar anterior displacement at immediate postoperation in group B [5.0 (4.3, 5.0) mm] was significantly shorter than that in group A [6.0 (5.0, 6.0) mm] ( P=0.013). There were no significant differences between the 2 groups in the talar inclination angle at immediate postoperation, or in the ankle-hindfoot AOFAS score or VAS at the last follow-up ( P>0.05). Postoperative incision healing was good in all patients. Probably due to intraoperative pulling up of the incision, superficial peroneal nerve numbness occurred in 1 case but recovered spontaneously. The subfibula bones in group B healed within 1 year. Conclusion:For chronic ankle instability in children with a large subfibular bone, preservation of the subfibular bone and ligament reinforcement can better restore the ankle anteroposterior stability.
