目的:腓骨肌腱脱位(PTD)的发生率相对较低,它在临床实践中经常被低估,这种情况的误诊或不当治疗可能导致患者生活质量下降。目前,PTD的手术治疗方案主要包括开放性手术和关节镜手术。然而,为了评估这两种手术方法的优缺点,需要进一步的比较研究。因此,本研究的目的是探讨关节镜和开放手术治疗Ogden1-2型PTD的早期临床结果.
方法:我们对2017年1月至2023年1月在我们机构接受手术的46例诊断为PTD的患者进行了全面分析。将患者分为两组:开放手术组,共26例,关节镜手术组,由20例组成。为了比较手术方法的有效性,我们评估了几个参数,包括MRI图像上腓骨上支持带的完整性,功能分数,疼痛干扰评分,和脚踝外翻肌肉力量。这些评估分别在手术前进行,手术后1个月,手术后3个月,并在每组患者的最后一次随访(术后至少6个月)。采用t检验或Mann-WhitneyU检验对两组数据进行人口统计和组间比较分析。两组数据的组内比较采用单因素方差分析(ANOVA)或Kruskal-Wallis检验,其次是事后多重比较。
结果:在组内比较中,关节镜手术和开放手术组在功能评分方面均有显着改善,疼痛干扰评分,肌肉力量,术后末次随访时的MRI表现(p<0.01)。然而,开放手术组在最终随访时这些结果显着改善,而关节镜手术组在术后3个月表现出显著改善。在组间比较中,关节镜手术组在功能评分方面优于开放手术组,疼痛干扰评分,手术后3个月的肌肉力量,差异有统计学意义(p<0.01)。
结论:关节镜手术在早期临床结局方面具有优势,如疼痛缓解,函数,和肌肉力量的改善。然而,随着时间的推移,两种方法在有效性方面提供了相似的结果.
OBJECTIVE: While the incidence of peroneal tendon dislocation (PTD) is relatively low, it is frequently underdiagnosed in clinical practice, and the misdiagnosis or improper treatment of this condition may lead to a decline in patients\' quality of life. Currently, the surgical treatment options for PTD mainly include open and arthroscopic surgery. However, in order to evaluate the advantages and disadvantages of these two surgical approaches, further comparative research is needed. Therefore, the aim of this study is to investigate the early clinical outcomes of arthroscopic and open surgery in the treatment of Ogden type 1-2 PTD.
METHODS: We conducted a comprehensive analysis of 46 patients diagnosed with PTD who underwent surgery at our institution between January 2017 and January 2023. The patients were divided into two groups: the open surgery group, consisting of 26 cases, and the arthroscopic surgery group, consisting of 20 cases. To compare the effectiveness of the surgical approach, we evaluated several parameters, including the integrity of the superior peroneal retinaculum on MRI images, functional scores, pain interference scores, and ankle eversion muscle strength. These assessments are conducted respectively before the surgery, 1 month after the surgery, 3 months after the surgery, and at the final follow-up for each group of patients (at least 6 months post-surgery). Demographics and intergroup comparisons of the two groups of data were analyzed by t-test or the Mann-Whitney U test. Intragroup comparisons of the two groups of data were analyzed by one-way analysis of variance (ANOVA) or the Kruskal-Wallis test, followed by post hoc multiple comparisons.
RESULTS: In the intragroup comparisons, both the arthroscopic surgery and the open surgery group demonstrated significant improvement in functional scores, pain interference scores, muscle strength, and MRI findings at the final follow-up postoperatively (p < 0.01). However, the open surgery group exhibited significant improvements in these outcomes at the final follow-up, while the arthroscopic surgery group showed significant improvement at 3 months postoperatively. In intergroup comparisons, the arthroscopic surgery group outperformed the open surgery group in functional scores, pain interference scores, and muscle strength 3 months after the surgery, with statistically significant differences (p < 0.01).
CONCLUSIONS: Arthroscopic surgery offers advantages in early clinical outcomes, such as pain relief, function, and muscle strength improvement. However, over time, both approaches provide similar results regarding effectiveness.