应用距下关节镜诊治跗骨窦综合征  

Application of arthroscope in treatment for sinus tarsi syndrome

作　　者：宋卫东[1] 陈炳豪[1] 刘文宙[1] 程翔宇[1] 杨涛[1] 常瑞明[1] 刘尚礼[1] 沈慧勇[1] 

机构地区：[1]中山大学孙逸仙纪念医院骨科,广州510120

出　　处：《中华关节外科杂志（电子版）》2014年第4期3-6,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的分析跗骨窦综合征在关节镜下的特征,评价应用关节镜治疗的临床效果。方法回顾性分析2012年1月至2014年1月,本院收治的15例诊断为跗骨窦综合征的病例。其中男6例,女9例;平均33.4岁（19~48岁）。其中,踝扭伤后11例,跟骨骨折后2例,胫腓骨骨折后1例,强直性脊柱炎1例。均应用距下关节镜检并行镜下手术。术前后应用直观模拟量表（VAS）评估术后疼痛改善情况,应用美国骨科足踝外科（AOFAS）踝-后足评分评估恢复效果,并记录相关并发症。结果关节镜下发现11例患者有不同程度的滑膜充血增生、脂肪纤维化、疤痕形成,有3例患者伴距跟骨间韧带的局部撕裂,1例伴腓骨肌腱损伤,1例伴距跟关节面软骨损伤;有2例患者镜下未见明显异常。针对不同病变,行跗骨窦区的增生滑膜、疤痕及脂肪组织清除,射频电极止血。术后平均随访16个月（6~28个月）,疼痛消失及明显缓解者13例,2例缓解不明显,其中,诊断强直性脊柱炎1例患者缓解3月后再发疼痛,经抗炎治疗缓解。AOFAS踝-后足评分均较术前明显改善,疼痛症状明显缓解,平均VAS评分从术前的7.7分下降到2.1分,优良率86.7%（13/15）。结论跗骨窦综合征在关节镜下常有明确的滑膜充血或增生等病理表现,通过关节镜手术可取得较优良的疗效。Objective To analyze the characteristics of sinus tarsi and subtalar joint in the patients with sinus tarsi syndrome by arthroscopy and to evaluate the curative effects of the arthroscopie treatment. Methods The data of 15 patients with sinus tarsi syndrome in our hospital from January 2012 to January 2014 were retrospectively analyzed. There were six males and nine females, aged from 19 to 48 years, 33.4 years in average. The symptoms were caused by ankle sprain in 11 cases, by calcaneal fracture in two cases, by tibial and fibular fractures in one case and by ankylosing spondylitis in one case. The Subtalar arthroscopic treatment was performed in all the cases. The pain relief was measured by the visual analog scale （VAS） and the operation effects were evaluated according to American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot scoring. The complications were recorded. Results According to the arthroscopy, 11 cases had synovial congestion and hyperplasia, adipose tissue fibrosis and scar formation in different degrees ; three cases presented the partial tear of interosseous talocaleaneal ligament; one case had peroneal tendon injury and one case had cartilage damage in the talocalcaneal joint. There was no obvious abnormity observed under the arthroscope in two cases. The surgical procedures included the removal of the hyperplastic synovial tissue, cicatricial tissue and adipose tissue and radiofrequency ablation. During the follow-up （from 6 to 28 months, 16 months in average）, the clinical and radiological outcomes were retrospectively evaluated. 13 cases achieved pain free or significant relief, yet there was no obvious pain relief in two cases. There was pain recurrence three months after the operation in one case that was diagnosed as ankylosing spondylitis and it was relieved again after the anti-inflammatory therapy. The postoperative AOFAS hindfoot score was （82. 00± 11.75 ）, which was significantly higher than the preoperative one [ （57.27 ± 11.87）, P 〈0. 01 ]. The mean V

关 键 词：踝损伤 距下关节 关节镜 

分 类 号：R681.5[医药卫生—骨科学]