外踝综合征的病因及解剖学基础

The Anatomy and Treatment of Lateral Malleolar Syndrome

目的:探讨外踝综合征所致外踝部顽固性步行痛及足背外侧麻刺痛的病因、诊疗方法及疗效.方法:对60张成人X线片的内外踝长度作了测量.内踝平均长15.26±1.56mm,外踝平均长27.56±3.14mm.从1989年7月～2004年7月,手术治疗外踝综合征51例56足,施行外踝尖部分切除51例56足;腓骨肌腱鞘及滑膜部分切除术45例49足(双侧4例);距跟骨外侧隆起的骨折块切除术18例19足;腓肠神经松解及跟外侧支切断术48例53足(双侧5例);外踝过长16例,手术修整过长过大的外踝及切除外踝骨刺9例,解除外踝碰撞和肌腱挤压,松解腓肠神经.结果:随访47例,随访期4个月～5年10个月,平均9个月,无一例感染,术后外踝步行痛消失,但跟骨骨折后创伤性扁平足未解决15例16足,非创伤性扁平足3例同时行距舟关节融合,恢复了足弓.结论:本病由于踝关节结构紊乱和外踝先天异常引起.以彻底解除病因为目的的手术治疗,简单易行,效果确实可靠.

Objective：To study the cause of intractable pedestrian pain in the lateral malleolus and numbness pain in the lateral instep, and investigate the diagnosis and curative effect of lateral malleolar syndrome. Methods：The X - ray films of 60 adult＇s ankle were observed. The length of the internal malleolus was （15.26 ± 1.56）mm and the lateral malleolus （27.56 ± 3.14）mm on the 51 cases of lateral malleolar syndrome and sural nerve compression were treated from July 1989 to July 2004 Partial excision of lateral malleolar tip was performed in 51 cases （56 feet） and partial excision of peroneal tendon sheath and synovial membrane in 45 cases （49 feet） ;The lateral prominent bone mass was cut off after the fracture of talus or calcaneus in 18 cases （ 19 feet） ; the sural nerve was loosend and the lateral calcanean branches cut in 48 cases （53 feet）. The lateral malleolar impingement and tendon squeezing were relieved;the meeism and oversize of the lateral malleolus were reconditioned in 16 eases. Results：47 eases were followed up for 4 - 70 months, 9 months on the average. None was infected. The pedestrain pain in the lateral malleolus disappeared after operation, but the flatfoot caused by caleaneus fracture remained unresolved. 3 eases of none traumatic flatfoot received talonavieular fusion and the foot arch was reluilt. Conclusion：This disease is caused by anatomical disorder in ankle and congenital lateral malkolar abnormality. The operation aiming at removing pathogenesis is simple and the effect is reliable.