From The Theory Of "Equal Emphasis On Bones And Tendons",the Clinical Efficacy Analysis Of Surgical Treatment Of Anterior Fibular Ligament Injury Was Explored

Objective: To explore the surgical treatment rationality of anterior talofibular ligament(ATFL)injury from the perspective of traditional Chinese medicine by comparing surgical repair with conservative treatment with external fixation of brace under the guidance of the theory of "equal emphasis on bones and tendons",and provide reference for clinical treatment of ATFL injury.Methods: 56 cases with ATFL injury who were admitted into the orthopaedic clinic of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from December 2019 to December 2020 were selected for clinical study,and divided into operation group and conservative treatment group: After admission,both groups were given the treatment of activating blood and dissolving stasis as well as reducing swelling and relieving pain.There were 28 cases in the operation group(18 males and 10females),with an average age of 34.86 ± 10.42 years old.Among them,13 cases suffered from left ATFL injury and 15 cases suffered from right ATFL injury,all of which were repaired by ATF incision under epidural anesthesia.In the conservative treatment group,there were 28 patients(18 males and 10females),with an average age of 41.25 ± 10.00 years old.Among them,12 cases suffered from left ATFL injury and 16 cases suffered from right ATFL injury.After admission,all patients were treated with detumescence and blood circulation,and fixed with plaster or brace.After treatment,the pain,range of motion,walking gait and movement status of the affected ankle joint were observed regularly,and the VAS scores and AOFAS scores of normal walking before,1 months,3 months,6 months after treatment between the operation group and the conservative group as well as the differences between the two groups were compared and analyzed,so as to evaluate the clinical efficacy.Results: 1.Both groups were followed up at 1 months,3 months,6 months after operation,and all patients were followed up effectively.2.Comparison of VAS scores between the two groups:(1)Comparison of VAS scores at different times in the operation group:The VAS scores in the operation group changed from(3.82 ± 0.67)before operation to(0.86 ± 0.52)at the last follow-up 6 months later,and the difference was statistically significant(t=24.614,p < 0.05);the VAS score of conservative treatment group changed from(3.50 ± 0.58)before operation to(0.86 ± 0.65)at the last follow-up 6 months later,and the difference was statistically significant(t=15.344,p < 0.05).(2)Comparison of VAS scores between the two groups: There was no significant difference in VAS scores before operation(t=1.924,p > 0.05),1months after operation(t=-1.009,p > 0.05),3 months after operation(t=-0.366,p > 0.05),and 6 months after operation(t=0,p > 0.05).3.Comparison of AOFAS scores between the two groups:(1)Comparison of AOFAS scores at different time in the operation group:The AOFAS scores in the operation group changed from(64.39 ± 4.72)before operation to(93.39 ± 2.71)at the last follow-up 6 months later,and the difference was statistically significant(t=-36.169,p < 0.05);The AOFAS score of conservative treatment group changed from preoperative(66.79 ±5.24)to last follow-up(87.32 ± 3.80)6 months later,and the difference was statistically significant(t=-21.766,p < 0.05).(2)Comparison of AOFAS scores between the two groups: There was no difference in AOFAS scores between the two groups before treatment(t=-1.795,p > 0.05);The AOFAS score in operation group was higher than that in conservative treatment group 1 months after operation,and the difference was statistically significant(t=8.718,p < 0.05).The AOFAS score in operation group was higher than that in conservative treatment group 3months after operation,and the difference was statistically significant(t=4.096,p < 0.05).The AOFAS score in operation group was higher than that in conservative treatment group 6 months after operation,and the difference was statistically significant(t=6.880,p < 0.05).4.According to the probability of ankle instability after follow-up for 6months,the probability of ankle instability in operation group(3.57%)was significantly lower than that in conservative treatment group(25.00%).5.After treatment,the ankle function of most patients in the two groups recovered well,the pain was relieved,the range of motion was good,and the daily life was greatly improved compared with that before treatment.Drawer test(-)and varus stress test(-).In the operation group,the incision healed well,without infection and nonunion;the skin around the incision felt good without numbness,and there was no limitation of varus movement,and 2cases had chronic ankle pain;In the conservative treatment group,5 patients suffered from moderate limitation of ankle varus and 2 patients suffered from chronic ankle pain.Conclusion: For acute ATFL injury,surgical treatment and conservative treatment with plaster and fixation can effectively relieve the pain of patients.However,due to the way of internal fixation,surgical treatment can remove plaster and fixture earlier than conservative treatment,and functional exercise is carried out.Therefore,it is more beneficial to the functional recovery of ankle joint in patients with ATFL injury.After operation,ankle joint function of patients recovers faster,and joint range of motion is better than conservative treatment,which can more effectively reduce the occurrence probability of chronic ankle instability,so it can resume daily life faster.