踝关节镜下前方联合跗骨窦入路及后外侧入路治疗踝关节前后联合撞击综合征  

Treatment of posterior and anterior ankle impingement syndrome with combined anterior, tarsal sinus and posterolateral approaches under arthroscopy

作　　者：宋斌[1] 李卫平[1] 陈仲[1] 杨睿[1] 侯景义[1] 谭伟权[1] 

机构地区：[1]中山大学孙逸仙纪念医院运动医学科,广州510120

出　　处：《中华创伤杂志》2015年第12期1085-1088,共4页Chinese Journal of Trauma

摘　　要：目的探讨踝关节前方人路联合跗骨窦入路及后外侧入路治疗踝关节前后联合撞击综合征的手术方法及疗效。方法选择2012年1月-2014年3月收治的12例踝关节前后联合撞击综合征患者，其中男8例，女4例；年龄17—65岁，平均45岁。左踝9例，右踝3例。8例有明确踝关节外伤史，其中急性扭伤5例，慢性扭伤3例，另外4例无明确外伤史。采用踝关节镜下前方入路联合跗骨窦入路及后外侧人路，同时清理前后踝骨赘，术中未采用俯卧位及增加后内侧入路。采用美国矫形外科足踝协会（AOFAS）后足-踝评分评估踝关节功能。结果手术时间45～80min，平均62min。关节镜下证实12例均存在前方骨性撞击，其中距骨后方骨赘3例，距后三角骨损伤9例。12例均获随访10—18个月，平均14个月。ACFAS评分从术前的（34．4±12．6）分提高至末次随访时的（91．4±6．5）分（t=14．607，P〈0．01）。所有患者术后关节活动度均达正常，术后均未出现血管神经损伤表现，切口均Ⅰ期愈合。结论关节镜下采用前方入路联合跗骨窦入路及后外侧入路治疗踝关节前后联合撞击综合征，术中可获得良好的踝关节前后视野，近期临床疗效满意。Objective To discuss the methods and effects of arthroscopic treatment of posterior and anterior ankle impingement syndrome through anterior approach, tarsal sinus approach plus posterolateral approach. Methods The study enrolled 12 patients with posterior and anterior ankle impingement syndrome treated from January 2012 to March 2014. There were 8 males and 4 females, aged17-65 years （mean, 45 years）. Left ankle injury was noted in 9 patients and right ankle injury in 3 patients. Eight patients had a history of obvious ankle injury （5 acute and 3 chronic sprains）. Arthroscopic surgery was performed to manage the posterior and anterior ankle impingement syndrome through the combined anterior, tarsal sinus and posterolateral approaches, and prone position and posteromedial incision were not used during operation. Postoperative outcome was evaluated using the American Orthopedic Foot and Ankle Society （AOFAS） score. Results Operation time was 45-80 min （mean, 62 rain ）. Arthroscopy confirmed anterior bone impingement in all patients. Three patients suffered from posterior bony impingement of the talus, while nine patients os trigonum injury. Duration of follow-up was 10 - 18 months （ mean, 14 months）. AOFAS score was （91.4 ± 6.5 ） points after operation, significantly higher （34.4± 12.6）points before operation （t = 14. 607, P 〈 0.01 ）. All patients had normal ankle range of motion after operation. There were no complications such as neurovascular injury. All the surgical incisions achieved primary healing. Conclusion The procedure avoids body position shift and posteromedial incision during operation, and attains a good vision to the anterior and posterior portions and satisfactory short-term outcome. [ Key words] Ankle injuries ; Arthroscopy; Impingement

关 键 词：踝损伤 关节镜检查 撞击 

分 类 号：R687.3[医药卫生—骨科学]