关节镜下清理术结合跟骨后上隆突成形术治疗跟骨后滑囊炎  

Arthroscopic debridement combined with posterosuperior calcaneoplasty for retrocalcaneal bursitis: technique and outcomes

作　　者：李棋[1] 李箭[1] 

机构地区：[1]四川大学华西医院骨科,运动医学中心,成都610041

出　　处：《第三军医大学学报》2015年第3期225-229,共5页Journal of Third Military Medical University

摘　　要：目的探讨关节镜下清理术结合跟骨后上隆突成形术治疗跟骨后滑囊炎的手术方法及临床疗效。方法回顾分析2011年1月至2013年1月本中心收治的8例跟骨后滑囊炎患者的临床资料,包括男性5例,女性3例,平均年龄42.2（32～53）岁;左侧2例,右侧6例;患者均无明确外伤史,病程10～35个月,均经过3～6个月保守治疗无效,采取手术治疗。手术采用关节镜下清理术结合跟骨后上隆突成形术治疗跟骨后滑囊炎。手术后第2天部分负重行走,术后3周后全负重行走,术后6～8周恢复日常生活及开始运动。术前和术后进行VAS、Tegner评分,观察并发症发生率。结果手术均顺利完成,手术时间30（18～35）min,所有患者未发生感染、腓肠神经损伤、关节活动受限、腓骨肌腱和跟腱损伤、挛缩等并发症。术后随访平均19（7～29）个月。术后复查X线片显示,跟骨后上突变为低平、光滑、圆钝。术前VAS评分为4～8（5.9±1.5）分;Tegner评分为2～4（2.4±1.0）分。至最后1次随访时VAS评分为0～3（1.8±0.7）分;Tegner评分为4～8（5.4±0.8）分。术后VAS评分较术前明显降低（P〈0.01）,Tegner评分较术前明显提高（P〈0.01）。结论关节镜下清理术结合跟骨后隆突成形术治疗跟骨后滑囊炎具有时间短、创伤小、康复快、疗效好的优点,但必须严格把握手术适应证。Objective To introduce the technique and investigate the outcomes of arthroscopic debridement combined with posterosuperior calcaneoplasty for retrocalcaneal bursitis. Methods Clinical data of 8 patients with retrocalcaneal bursitis undergoing arthroscopic debridement combined with posterosuperior calcaneoplasty in our department from January 2011 to January 2013 were collected and retrospectively reviewed. They were 5 males and 3 females with a mean age of 42. 2 years（ ranging from 32 to53）,and 6 of them were hurt in right side and 2 in left. All patients did not have a clear history of trauma,had a duration of 10 to 35 months,and experienced conservative treatment for average 3 to 6 months which was failed and then turned to surgical treatment. In 2 d after surgery,the patients begun partial weight-bearing walking,then followed by full weight-bearing walking in 3 weeks after surgery,and restored daily life and started moving after 6 to 8 weeks. Pre- and post-operative radiography,visual analogue scale（ VAS） and Tegner scores were recorded and compared. Postoperative complications were also observed. Results All of the patients underwent the surgery successfully,with a mean operation time of 30 min（ 18 to 35）. After surgery,there was no case with any complications,such as infection,nerve or tendon injury,restricted range of motion,or Achilles tendon contracture. The average time of follow-up was 19 months（ 7- 29）. On the post-operative radiographs,the calcaneal posterosuperior protuberance became blunter and rounder. Tegner scores was increased significantly from 2. 4 ± 1. 0（ 2- 4） before surgery to 5. 4 ± 0. 8（ 4- 8） after（ P〈0. 01）. There was a significant decrease in VAS post-operatively than that pre-operatively [1. 8 ± 0. 7（ 0- 3）vs 5. 9 ± 1. 5（ 4- 8）,P〈0. 01]. Conclusion For patients with chronic retrocalcaneal bursitis,arthroscopic debridement combined with posterosuperior calcaneoplasty is an effective option with short operation time,small wound and rapid effi

关 键 词：跟腱 跟骨后滑囊炎 关节镜 清理术 跟骨后隆突成形术 

分 类 号：R684.3[医药卫生—骨科学] R687.42[医药卫生—外科学]