关节镜技术治疗前外侧踝关节撞击综合征  

Arthroscopic treatment for anterolateral ankle impingement syndrome

作　　者：杨家骥[1] 刘云鹏[1,2] 王星亮[1] 李坤[2] 华国军[2] 

机构地区：[1]安徽医科大学无锡临床学院,无锡214044 [2]解放军第101医院骨科,无锡214044

出　　处：《中国矫形外科杂志》2015年第8期696-700,共5页Orthopedic Journal of China

基　　金：南京军区医学科研基金(编号:10MA009)

摘　　要：[目的]探讨前外侧踝关节撞击综合征的病因及关节镜治疗效果。[方法]回顾分析踝关节镜技术治疗的22例前外侧踝关节撞击综合征患者。所有患者均行关节镜清理,清除撞击组织,修整损伤的软骨。采用AOFAS评分系统和Meislin标准对疗效进行评估。[结果]22例患者术后均获得随访（随访时间12~24个月,平均16.8个月）,镜下发现均存在前外侧踝撞击,撞击物类型：外侧滑膜组织撞击12例,半月板样组织撞击3例,下胫腓前韧带远侧束撕裂撞击3例,距腓前韧带损伤瘢痕组织增生撞击4例。AOFAS评分由术前的（46.27±12.50）分提高到末次随访时的（85.14±10.20）分,手术前后差异具有统计学意义（P〈0.05）。采用Meislin标准进行疗效评估,优8例,良10例,可4例,差0例,优良率81.82%。[结论]踝关节前外侧撞击综合征多发生在踝关节反复损伤后,撞击物多为增生瘢痕组织,可合并出现关节软骨损伤。关节镜是诊断和治疗踝关节前外侧软组织撞击综合征的有效手段,具有创伤小、恢复快、疗效好等优点。[Objective]To investigate the pathology and arthroscopic treatment outcome of anterolateral ankle impingement syndrome.[Method]The study reviewed 22 patients with soft tissue impingement syndrome of the anterolateral ankle who were treated arthroscopically.Arthroscopic intervention included clearing the impingement soft tissue and removing osteochondral fragments.The effect of surgery was assessed by hind foot-ankle scoring of American Othopedic Foot and Ankle Society（AOFAS）and Meislin＇s criteria.[Result]All patients were followed up for 12-24 months（average of 16.8 months）.Of the 22 patients,12 associated with synovial tissue impingement,3 with meniscoid tissue impingement,3 with injury scar tissue impingement of distal fascicle of anterior tibiofibular ligament,and 4 with fibrous scar tissue impingement of anterior talofibular ligament.In addition,15 patients of them combined with articular cartilage damage.The AOFAS scores significantly increased from（46.27 ±12.50） points preoperatively to（85.14 ± 10.20） points（P〈0.05） at the latest follow up.Based on Meislin＇s criteria,outcome was graded as being excellent in 8 patients,good in 10,fair in 4,and none was scored as poor.The excellent and good results rate was 81.82%.The relationship between impingement pathology and cartilage damage was not significant（X2= 1.856,P = 1.73）.However,outcome was associated with cartilage damage（Z = 3.250,P = 0.01）.[Conclusion]The soft tissue impingement syndrome of the anterolateral ankle often occurs following ankle sprain.The impingement soft tissues are the hyperplasia of scar tissue,and articular cartilage damage occur concomitantly in the most cases.Arthroscopy to diagnose and treat soft tissue impingement syndrome of the anterolateral ankle is an effective,simple,safe and minimally invasive method.

关 键 词：关节镜 踝关节撞击综合征 软骨损伤 

分 类 号：R687.4[医药卫生—骨科学]