22例后踝撞击综合征的关节镜下治疗体会
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摘要
(1)目的探讨并总结关节镜下治疗后踝撞击综合征的疗效。(2)方法选取因后踝撞击综合征手术治疗的患者22例,其中男15例,女7例;年龄21～62岁,平均(38.7±11.0)岁;右踝17例,左踝5例。17例有明确踝关节外伤史。采用跟腱旁入路行关节镜下探查清理等治疗。通过美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)后足-踝评分及疼痛视觉模拟评分(Visual Analogue Scale,VAS)评价踝关节功能。(3)结果所有患者术后均获得随访,平均随访时间(12.5±5.3)个月(4～22个月)。AOFAS评分从术前的(35.2±10.9)分提高至末次随访时的(90.0±3.9)分,(t=-20.5,P <0.01);VAS评分从术前的(6.5±2.1)分下降为末次随访时的(2.7±1.5),(t=9.4,P <0.01);踝关节跖屈角度从术前的(30.0±2.3)度提高至末次随访时的(43.2±1.4)度,(t=-29.0,P <0.01)。所有患者术后切口愈合好,无神经血管损伤并发症,关节活动度正常。(4)结论后踝撞击综合征的关节镜下治疗,疗效可靠,具有微创,精准等优点。
Objective To discuss and summarize the effects of arthroscopic treatment of posterior ankle impingement syndrome.Methods The study enrolled 22 patients with posterior ankle impingement syndrome treated.There were 15 males and 7females,Aged 21～62years(mean,(38.7±11.0)years).Right ankle injury was noted in 17 patients and left ankle in 5patients.17 patients had a history of obvious ankle injury.The side approach of achilles tendon was used for arthroscopic exploration and cleaning.Postoperative outcome was evaluated using the American Orthopedic Foot and Ankle Society(AOFAS)score and visual analogue scale(VAS)score.Results All the patients were foIlowed up for4-22months(mean,(12.5±5.3)months).These patients got a good healing without nervus and vascular injuries and they had normal ankle range of motion after operation.AOFAS score was(90.0±3.9)points after operation,significantly higher(35.2±10.9)points before operation(t=-20.5,P <0.01).VAS score was(6.5±2.1)points after operation,significantly lower(2.7±1.5)points before operation(t=9.4,P <0.01).The ankle joint flexion angle improved significantly from(30.0±2.3)degree to(43.2±1.4)degree compared with preoperative status(t=-29.0,P <0.01).Conclusion Arthroscopy is one of the effective methods for the posterior ankle impingement syndrome,which has the advantages of minimally invasive,precision and so on.
Objective To discuss and summarize the effects of arthroscopic treatment of posterior ankle impingement syndrome.Methods The study enrolled 22 patients with posterior ankle impingement syndrome treated.There were 15 males and 7females,Aged 21～62years(mean,(38.7±11.0)years).Right ankle injury was noted in 17 patients and left ankle in 5patients.17 patients had a history of obvious ankle injury.The side approach of achilles tendon was used for arthroscopic exploration and cleaning.Postoperative outcome was evaluated using the American Orthopedic Foot and Ankle Society(AOFAS)score and visual analogue scale(VAS)score.Results All the patients were foIlowed up for4-22months(mean,(12.5±5.3)months).These patients got a good healing without nervus and vascular injuries and they had normal ankle range of motion after operation.AOFAS score was(90.0±3.9)points after operation,significantly higher(35.2±10.9)points before operation(t=-20.5,P <0.01).VAS score was(6.5±2.1)points after operation,significantly lower(2.7±1.5)points before operation(t=9.4,P <0.01).The ankle joint flexion angle improved significantly from(30.0±2.3)degree to(43.2±1.4)degree compared with preoperative status(t=-29.0,P <0.01).Conclusion Arthroscopy is one of the effective methods for the posterior ankle impingement syndrome,which has the advantages of minimally invasive,precision and so on.
引文
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[8]韩冠生,徐斌,耿春晖,等.关节镜下治疗踝关节撞击征的疗效观察[J].中国修复重建外科杂志,2014,28(6):673-676
[9]Zengerink M,van Dijk CN.Complications in ankle arthroscopy[J].Knee Surg Sports Traumatol Arthrosc,2012,20(8):1420-1431
[10]Ferkel RD.In which position do we perform arthroscopy of the hindfoot——supine or prone?Commentary on an article by Florian Nickisch,MD,et al.“Postoperative complications of posterior ankle and hindfoot arthroscopy”[J].J Bone Joint Surg Am 2012,94(5):e33
[11]李振伟,黄德刚,韩冠生.关节镜下治疗踝关节后方撞击综合征[J].中国微创外科杂志,2017,17(6):240-242
[12]魏民,刘洋.关节镜治疗后踝撞击征的临床观察[J].中国骨伤,2016,29(12):1084-1087
[13]Phisitkul P,Tennant JN,Amendola A.Is there any value to arthroscopic debridement of ankle osteoarthritis and impingement?[J].Foot Ankle Clin,2013,18(3):449-458
[14]Murawski CD,Kennedy JG.Operative treatment of osteochondral lesions of the talus[J].J Bone Joint Surg Am,2013,95(11):1045-1054
[15]Coetzee JC,Seybold JD,Moser BR,et al.Management of Posterior Impingement in the Ankle in Athletes and Dancers[J].Foot Ankle Int,2015,36(8):988-994
[2]Yasui Y,Hannon CP,Hurley E,et al.Posterior ankle impingement syndrome:A systematic four-stage approach[J].World J Orthop,2016,7(10):657-663
[3]Ribbans WJ,Ribbans HA,Cruickshank JA,et al.The management of posterior ankle impingement syndrome in sport:a review[J].Foot Ankle Surg,2015,21(1):1-10
[4]Gasparetto F,Collo G,Pisanu G,et al.Posterior ankle and subtalar arthroscopy:indications,technique,and results[J].Curr Rev Musculoskelet Med,2012,5(2):164-170
[5] Nishimura A,Nakazora S,Ito N,et al.Endoscopic All-inside Repair of the Flexor Hallucis Longus Tendon in Posterior Ankle Impingement Patients[J].Arthrosc Tech,2017,6(5):e1829-e1835
[6] Dimmick S,Linklater J.Ankle impingement syndrome[J].Radiol Clin North Am,2013,51(3):479-510
[7]张宏斌,张培训,钱源,等.距后三角骨损伤的微创手术治疗[J].中华骨与关节外科杂志,2015,8(4):296-299
[8]韩冠生,徐斌,耿春晖,等.关节镜下治疗踝关节撞击征的疗效观察[J].中国修复重建外科杂志,2014,28(6):673-676
[9]Zengerink M,van Dijk CN.Complications in ankle arthroscopy[J].Knee Surg Sports Traumatol Arthrosc,2012,20(8):1420-1431
[10]Ferkel RD.In which position do we perform arthroscopy of the hindfoot——supine or prone?Commentary on an article by Florian Nickisch,MD,et al.“Postoperative complications of posterior ankle and hindfoot arthroscopy”[J].J Bone Joint Surg Am 2012,94(5):e33
[11]李振伟,黄德刚,韩冠生.关节镜下治疗踝关节后方撞击综合征[J].中国微创外科杂志,2017,17(6):240-242
[12]魏民,刘洋.关节镜治疗后踝撞击征的临床观察[J].中国骨伤,2016,29(12):1084-1087
[13]Phisitkul P,Tennant JN,Amendola A.Is there any value to arthroscopic debridement of ankle osteoarthritis and impingement?[J].Foot Ankle Clin,2013,18(3):449-458
[14]Murawski CD,Kennedy JG.Operative treatment of osteochondral lesions of the talus[J].J Bone Joint Surg Am,2013,95(11):1045-1054
[15]Coetzee JC,Seybold JD,Moser BR,et al.Management of Posterior Impingement in the Ankle in Athletes and Dancers[J].Foot Ankle Int,2015,36(8):988-994