关节镜下唐氏入路治疗前、后踝撞击综合征疗效分析  

Effectiveness of Tang’s arthroscopy approach for anterior and posterior ankle impingement syndrome

作　　者：张洪鑫[1,2] 翟龙地 潘昭勋[1] 于洪昌[1] 朱金航 唐康来 ZHANG Hongxin;ZHAI Longdi;PAN Zhaoxun;YU Hongchang;ZHU Jinhang;TANG Kanglai(Department of Orthopedics Surgery,the 89th Hospital of Chinese PLA,Weifang Shangdong,261021,P.R.China;Department of Orthopedics/Sports Medicine Center,the First Affiliated Hospital of Army Medical University(the Third Military Medical University),Chongqing,400038,P.R.China)

机构地区：[1]中国人民解放军第89医院骨科,山东潍坊261021 [2]陆军军医大学(第三军医大学)第一附属医院骨科运动医学中心,重庆400038

出　　处：《中国修复重建外科杂志》2019年第11期1340-1344,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目（81230040）;国家重点研发计划资助项目（2016YFC1100500）~~

摘　　要：目的探讨关节镜下唐氏入路治疗前、后踝撞击综合征的疗效。方法回顾分析2010年8月-2017年9月采用侧卧漂浮体位关节镜下唐氏入路治疗的58例前、后踝撞击综合征患者(A组)临床资料,并与采用传统术式治疗的34例患者(B组)进行比较。两组患者性别、年龄、体质量指数、侧别、病程以及术前美国矫形足踝协会(AOFAS)、疼痛视觉模拟评分(VAS)等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间,采用AOFAS评分、VAS评分评价关节功能及疼痛程度,采用Roles-Maudsley评分评价患者主观满意度。术后12个月复查X线片及MRI。结果 A组手术时间中位数为50.5 min [95%CI(49.3,54.6)],较B组88.5 min[95%CI(76.5,92.8)]明显缩短(Z=-4.685,P=0.000)。A组切口Ⅰ期愈合;B组2例切口愈合不良,经清创后愈合。两组患者均获随访,A组随访时间(54.7±18.8)个月,B组为(55.4±17.9)个月,差异无统计学意义(t=-0.178,P=0.859)。术后12个月侧位X线片复查显示A组2例(3.4%)、B组1例(2.9%)距骨后突磨除不彻底,差异无统计学意义(χ2=0.014,P=0.699)。末次随访A、B组AOFAS评分分别为(83.1±6.6)、(85.2±6.4)分,VAS评分分别为(1.3±1.1)、(1.6±1.0)分,均较术前明显改善(P<0.05),组间差异无统计学意义(P>0.05)。A组患者主观满意度评分中位数为2.0分[95%(1.4,1.7)],优于B组2.0分[95%(1.6,2.2)](Z=-2.480,P=0.013)。结论关节镜下经唐氏入路治疗前、后踝撞击综合征手术时间短、操作简便,可获得较好疗效,患者满意度高。Objective To investigate the effectiveness of Tang’s arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome. Methods Between August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang’s arthroscopy approach under floating decubitus(group A) and 34 patients were treated with standard anterior and posterior approaches(group B). There was no significant difference in gender, age, body mass index, side,disease duration, preoperative American Orthopaedic Foot and Ankle Society(AOFAS) score, and preoperative visual analogue scale(VAS) score between the two groups(P>0.05).The operation time, AOFAS score, VAS score, and RolesMaudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The Xray film and MRI at 12 months were used to observe the ankle impingement. Results Median operation time of group A was 50.5 minutes [95%CI(49.3, 54.6)], which was significantly shorter than that of group B [88.5 minutes, 95%CI(76.5, 92.8)](Z=-4.685, P=0.000). All incisions in group A healed by first intention;while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was(54.7±18.8) months, while that of group B was(55.4±17.9) months, and there was no significant difference between the two groups(t=-0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases(3.4%) of group A and 1 case(2.9%) of group B. There was no significant difference in the incidence between the two groups(χ2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B;the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones(P<0.05), but there was no significant difference between the two groups(P>0.05). The median subjective s

关 键 词：踝关节撞击综合征 前踝 后踝 手术入路 关节镜 

分 类 号：R68[医药卫生—骨科学]