摘要
目的探讨关节镜下治疗踝关节撞击征的疗效。方法2009年3月～2013年4月，收治30例踝关节撞击征患者。男22例，女8例；年龄16～55岁，平均28．6岁。26例有明确踝关节扭伤史。病程6～62个月，平均21．5个月。30例均有踝关节疼痛、活动受限，踝关节撞击试验均为阳性。术前采用Meislin疗效评估，良5例，可8例，差17例，优良率16．7‰美国足踩外科协会（AOFAS）评分为（43．3±5．1）分；疼痛视觉模拟评分（VAS）为（6．7±2．3）分。x线片示6例存在关节游离体和增生骨赘，4例外踝陈旧性撕脱骨折。MRJ检查示17例踝关节内有软组织，7例胫距关节软骨损伤及骨髓水肿。关节镜下明确撞击部位、程度及撞击组织，行关节清理、游离体取出、骨赘去除、软骨成形、内外侧韧带等离子消融皱缩等治疗。结果术后患者切口均I期愈合，无神经、血管损伤及关节腔感染等并发症发生。30例均获随访，随访时间6～32个月，平均19．5个月。末次随访时，采用Meislin疗效评估，获优16例，良11例，可3例，优良率90．0％，与术前比较差异有统计学意义（Z=6．045，P=0．000）；AOFAS评分为（89．8±4.3）分，与术前比较差异有统计学意义（t=38．180，P=0．000）；VAS评分为（2．8±1．6）分，与术前比较差异有统计学意义（t=7．624，P=0．000）。结论通过关节镜下模拟撞击，明确撞击特点，并针对性进行关节清理及合并症处理，是治疗踝关节撞击征的有效方法之一，具有针对性强、创伤小、恢复快的优点。
Objective To explore the effectiveness of arthroscopy for ankle impingement syndrome. Methods Between March 2009 and April 2013, 30 patients with ankle impingement syndrome were treated. Among them, there were 22 males and 8 females with an average age of 28.6 years （range, 16-55 years）. Twenty-six patients had a history of obvious ankle sprains. The disease duration was 6-62 months （mean, 21.5 months）. All cases had ankle pain, limitation of activity, and positive results of ankle impact test. According to Meislin scoring criteria, 5 cases were rated as good, 8 cases as medium, and 17 cases as poor; the excellent and good rate was 16.7%. American Orthopedic Foot and Ankle Society （AOFAS） score was 43.3 ± 5.1. Visual analogue scale （VAS） score was 6.7 ± 2.3. Preoperative X-ray film showed ankle loose bodies and hyperplasia osteophyte in 6 cases, and lateral malleolus old avulsion fracture in 4 cases. MR] showed soft tissue in the ankle joint in the 17 cases, and articular cartilage injury of tibiotalar joint and bone marrow edema in 7 cases. The location, degree, and organization of the impact were observed under arthroscopy. The joint debridement, removal of loose body and osteophyte, plasty of articular cartilage, and plasma radiofrequency ablation of lateral and medial ligaments were performed. Results All incisions healed primarily. No infection of skin and joint, or neurological and vascular injury was found. All patients were followed up 6-32 months （mean, 19.5 months）. According to Meislin scoring criteria at last follow-up, 16 cases were rated as excellent, 11 cases as good, and 3 cases as medium; the excellent and good rate was 90.0%, showing significant difference when compared with preoperative value （Z=6.045, P=0.000）. AOFAS score was 89.8 ± 4.3, showing significant difference when compared with preoperative score （t=38.180, P=0.000）. VAS score was 2.8 ± 1.6, showing significant difference when compared with preoperative score （t=7.624, P=0.000）. Conclusion A clear understanding of impingement characteristics, pertinent joint debridement, and complication treatment are important to treat ankle impingement syndrome by simulating ankle impingement under arthroscopy, which have the advantages of strong pertinence, less injury, and fast recovery.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第6期673-676,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
踝关节撞击征
关节镜
关节功能
Ankle impingement syndrome Arthroscopy Joint function
