关节镜手术治疗距骨软骨损伤合并下胫腓联合不稳的临床疗效观察  

Clinical observation of arthroscopic treatment of osteochondral lesion of talus combined with tibiofibular syndesmosis instability

作　　者：俞嘉锫 申成春[1] 黄雷[1] 张峰[1] 贺萍萍[1] 朱彦昭[1] YU Jiapei;SHEN Chengchun;HUANG Lei;ZHANG Feng;HE Pingping;ZHU Yanzhao(Department of Foot and Ankle Surgery,Ningbo N0.6 Hospital,Ningbo,Zhejiang 315040,China)

机构地区：[1]宁波市第六医院足踝外科,浙江315040

出　　处：《中国骨与关节损伤杂志》2025年第2期156-160,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的总结距骨软骨损伤合并下胫腓联合不稳的临床特点,评估关节镜手术治疗此类损伤的临床疗效。方法回顾性分析自2017-07—2022-06采用关节镜手术治疗的58例距骨软骨损伤合并下胫腓联合不稳,置入4.0 mm关节镜对踝关节内进行全面探查,进行踝关节腔内部分清理,清除剥脱的软骨,修整软骨壁,然后进行微骨折处理。关节镜下清理下胫腓间隙内炎性滑膜,于踝关节面上方3 cm处沿腓骨外侧缘置入导针并扩髓,置入带袢钢板固定下胫腓关节。比较术前与末次随访时疼痛VAS评分、踝与后足功能AOFAS评分、SF-36评分、踝关节活动度。结果关节镜对距骨软骨损伤部位分类:12例位于距骨软骨面1区,4例位于距骨软骨面3区,38例位于距骨软骨面4区,4例位于距骨软骨面6区;7例为距骨内外侧软骨损伤。关节镜下探查距骨软骨损伤面积为0.56~1.08 cm2,平均0.89 cm2。58例均获得随访,随访时间13~62个月,平均33.8个月。术后1年关节镜下探查结果显示距骨软骨无缺损及剥脱,无下胫腓间隙内滑膜炎及下胫腓联合不稳发生,22例距骨软骨损伤处被完整的纤维软骨覆盖。末次随访时疼痛VAS评分、踝与后足功能AOFAS评分、SF-36评分、踝关节活动度均较术前明显改善,差异有统计学意义(P<0.05)。结论关节镜下微骨折技术、下胫腓间隙清理、带袢钢板固定下胫腓联合是距骨软骨损伤合并下胫腓联合不稳的有效手术方法,微骨折处理和下胫腓间隙内炎性滑膜清理是解除临床症状的关键因素,而带袢钢板固定下胫腓联合可以提高手术成功率。Objective syndesmosis instability systematically,and to evaluate the clinical efficacy of arthroscopic surgery in treating these injuries.MethodsA retrospective analysis was conducted on 58 cases of osteochondral lesion of the talus combined with tibiofibular syndesmosis instability treated by arthroscopic surgery from July 2017 to June 2022.A 4.0 mm arthroscope was utilized for a comprehensive exploration of the ankle joint,including partial debridement of the ankle cavity,removal of detached cartilage fragments,repair of the cartilage surface,and subsequent microfracture treatment.The inflammatory synovium within the distal tibiofibular space was also debrided under arthroscopic guidance.A guide needle was inserted along the lateral border of the fibula,approximately 3 cm above the ankle articular surface,followed by the placement of suture button to stabilize the distal tibiofibular joint.Preoperative and final follow-up assessments were compared using the Visual Analog Scale(VAS)for pain,the American Orthopaedic Foot and Ankle Society(AOFAS)score for ankle and hindfoot function,the Short Form-36(SF-36)health survey,and ankle range of motion.ResultsArthroscopic classification of the injured sites of talus cartilage was as follows:12 cases were located in zone 1,4 cases in zone 3,38 cases in zone 4,and 4 cases in zone 6 of the talus cartilage surface.Additionally,7 cases exhibited injuries to both the medial and lateral aspects of the talus cartilage.The mean injury area was0.89 cm2(range:0.56-1.08 cm2).All 58 patients were followed up for 13 to 62 months(mean:33.8 months).One year after operation,arthroscopic examination revealed no defects or stripping of the talus cartilage,no synovitis in the lower tibiofibular space,and no instability of the tibiofibular syndesmosis.Complete fibrocartilage coverage was observed in 22 cases of talus cartilage injury.At the final follow-up,significant improvements were noted in the pain VAS score,AOFAS ankle-hindfoot function score,SF-36 score,and ankle joint motion,with sta

关 键 词：距骨软骨损伤 下胫腓联合不稳 关节镜 微骨折技术 带袢钢板 

分 类 号：R687.3[医药卫生—骨科学]