后踝撞击合并长屈肌腱病变的关节镜治疗  

Arthroscopic treatment of posterior ankle impingement combined with tendinopathy of flexor hallucis longus

作　　者：刘波 刘自金 LIU Bo;LIU Zi-jin(Department of Orthopedicst The Second People's Hospital of Shandong Province,Jinan 250022,China)

机构地区：[1]山东省第二人民医院骨科,山东济南250022

出　　处：《中国矫形外科杂志》2021年第22期2089-2092,共4页Orthopedic Journal of China

摘　　要：[目的]介绍关节镜术治疗后踝撞击综合征伴长屈肌腱病变的手术技术和初步临床疗效。[方法]2018年10月-2019年12月采用关节镜术治疗距后三角骨或巨大距骨后外侧凸并长屈肌腱腱病20例。建立跟腱旁后内及后外双入路至距后内侧,灌注扩张,清除软组织,显露长屈肌腱,于肌腱前外侧显露距后三角骨或巨大距骨后外侧凸,切除嵌压的骨赘,松解修复长屈肌腱。[结果]所有患者均顺利完成手术,无严重并发症。随访时间15~30个月,平均(23.20±4.25)个月,A0-FAS评分由术前(68.10±3.97)分显著增加至末次随访时(94.40±2.30)分(P<0.05),VAS评分由术前(7.25±0.72)分显著减少至末次随访时(1.00±0.65)分(P<0.05)。[结论]经后方入路踝关节镜下治疗后踝撞击综合征伴长屈肌腱病变手术安全,临床效果满意,踝关节功能恢复良好。[Objective]To introduce the surgical technique and preliminary clinical results of arthroscopic treatment of posterior ankle impingement syndrome accompanied with flexor hallucis longus tendinopathy.[Methods]From October 2018 to December 2019,20 patients underwent arthroscopic treatment for flexor hallucis longus tendinopathy accompanied with posterior os trigonum or giant talus posterolateral protuberance.After establishing the medial and posterior lateral portals on medial side of the Achilles tendon,an arthroscope and instruments were introduced,and remove the soft tissues posterior to the talus to expose the flexor longus tendon.After the posterior os trigonum or the posterolateral protuberance of the talus was identified from the anterolateral side of the tendon,the impinging osteophyte was resected and removed,and then release the hallux flexor tendon,repaired it if necessary.[Results]All patients had operation per-formed smoothly without serious complications,and followed up for 15〜30 months,with an average of(23.20±4.25)months.The AOFAS score increased significantly from(68.10±3.97)before operation to(94.40±2.30)at the last follow-up(P<0.05).In addition,the VAS score significantly reduced from(7.25±0.72)preoperatively to(1.00±0.65)at the latest follow-up(P<0.05).[Conclusion]This posterior ankle arthroscopy is a safe treatment for posterior ankle impingement syndrome accompanied with hallux flexor longus tendinopathy,and achieves satisfactory clinical results and good recovery of ankle function.

关 键 词：后踝撞击综合征 距后三角骨 长屈肌腱 关节镜术 

分 类 号：R687.4[医药卫生—骨科学]