慢性跟腱炎的分型与关节镜微创治疗

Classification and arthroscopic surgery of chronic achilles tendinitis

目的观察慢性跟腱炎的分型与局部麻醉下关节镜微创治疗的效果。方法2003年3月至2009年3月，采用局部麻醉下关节镜微创治疗慢性跟腱炎22例，男16例，女6例，年龄17—53岁，平均33．5岁。运动损伤16例，病因不明6例。术前根据X线片、MR／检查、CT扫描和临床特点，将其分为：增生肥大型（10例）、钙化结节型（5例）和纤维撕裂型（7例）。分别采用局麻关节镜下等离子刀消融、创削清理术治疗。结果术后随访22例，平均随访14个月（9～54个月），采用制定的评定标准和VAS评分进行疗效评价，优：12例，良8例，可2例。无血管神经损伤、感染和跟腱断裂等并发症。结论跟腱炎分型有助于临床诊断和治疗方案制定；局麻关节镜下微创治疗慢性跟腱炎方法可行，操作简便，疗效显著。

Objective To investigate the clinical classification of chronic achilles tendinitis and analyze the surgical technique and efficacy of arthroscopic surgery. Methods Twenty-two patients （ 16 males, 6 females） with chronic achilles tendinitis were recruited. The average age was 33.5 years old （ range ： 17-53 ）. Sixteen cases were caused by sport injury while 6 cases had no definite etiological factor. The Achilles tendinopathy was divided into three types according to clinical characteristics and the results of X ray, CT scan and MRI examination of ankle： Type 1, hypertrophy （n = 10） ; Type 2, calcified tubercle （ n = 5 ） ; Type 3, fiber tear （ n = 7 ）. All cases were treated with endoscopic debridement of ventral neovascularized area, peritendineum and Achilles tendon by shaver and radiofrequency （RF） probe. Results The patients were followed-up for a mean of 14 months （ range ： 9-15 ）. Evaluated by our criteria and visual analogue scale, the post-operative efficacy was excellent in 12 cases, good in 8 and fair in 2. No postoperative complications, such as neurovascular injury, infection and rupture of Achilles tendon, was recorded. Conclusion This scheme of classifying is helpful to the diagnosis and effective treatment of chronic Achilles tendonitis. With a high safety and a satisfactory efficacy, arthroscopic surgery has the advantages of minimally invasiveness.