距小腿(踝)关节软组织撞击综合征的功能重建

Functional reconstruction of talocrural (ankle) joint soft tissue after impingement syndrome

目的:距小腿(踝)关节软组织损伤是常见的运动损伤,影响日常生活和生活质量,危害性及早期诊断与治疗的重要性逐渐为医学界所重视,本文对长期以来学者们所做的大量研究进行综述,总结距小腿关节软组织撞击综合征的功能重建的最新进展。资料来源:通过计算机检索Medline1990-01/2004-12关于距小腿关节软组织撞击综合征的文献,检索词“AnkleImpingementsyndrome,diag-nosis,treatment”,限定语言种类为English。同时检索1990-01/2004-12中国全文期刊数据库有关距小腿关节软组织撞击综合征的文献,检索词:“踝关节;踝损伤;踝外侧韧带”,限定语言种类为中文。资料选择:选择与距小腿关节软组织损伤相关的观察对比研究、经验总结、个案报告等文献,检索该最新的研究进展,力求资料全面。排除重复性研究。资料提炼:共收集有关距小腿关节软组织损伤相关的文献40篇,排除重复性研究13篇。纳入27篇。其中有关距小腿关节软组织撞击综合征的定义2篇,关于其诊断10篇,关于其治疗14篇,关于其新发展1篇。资料综合:距小腿关节无骨折脱位的长期肿痛称为距小腿关节软组织撞击综合征。发病机制为距小腿关节周围组织损伤,体征表现为距小腿关节活动受限,畸形。脚底被迫屈曲状态是诊断的关键。辅助检查可通过影像学,关节镜检查,MR关节造影术进行。其治疗采用非手术治疗(局部外固定,外敷,超声中频调制电疗法,传统医学)和关节镜下手术治疗,新出现的钬激光使距小腿关节镜手术有更明显优势。结论:结合距小腿关节软组织损伤的特点,以早期诊断为方向,选用适宜的治疗方案,开发新的仪器减少不必要的手术治疗,但同时应寻找最佳的手术时机,研究最佳的手术方式,将手术的损伤减到最低。

OBJECTIVE： Talocrural （ankle） joint soft tissue injury is a common sports injury, which can affect the activities of daily life and quality of life, its damage and importance of early diagnosis and treatment have gradually attract the attention of medical field. This paper reviewed the long-term plenty of studies by scholars, and summarized the latest progress of the functional reconstruction of talocrural joint soft tissue after impingement syndrome. DATA SOURCES： A computer-based online search of Medline database was undertaken to identify articles about impingement syndrome of talocrural joint soft tissue published in English between January 1990 and December 2004 with the keywords of “ankle impingement syndrome, diagnosis, treatment”. Meanwhile, Chinese articles about the impingement syndrome of talocrural joint soft tissue published between January 1990 and December 2004 were. retrieved in China National Knowledge Infrastructure （CNKI）, the keywords were “ankle joint, ankle injury, lateral ligament of ankle“ in Chinese. STUDY SELECTION： The literatures of observation and comparative study, experience summary, case report about talocrural joint soft tissue injury were selected, and the latest investigative progress was retrieved to obtain overall data. Repetitive studies were deleted. DATA EXTRACTION： Totally 40 articles about talocrural joint soft tissue injury were collected, 13 repetitive studies were deleted, and 27 were involved, including 2 about the definition of impingement syndrome of talocrural joint soft tissue, 10 about the diagnosis, 14 about the treatment, and 1 about the new development. DATA SYNTHESIS： The long-term swelling and pain of talocrural joint without fracture-dislocation are called the impingement syndrome of talocrural joint soft tissue. The pathogenesis is the talocrural joint peripheral tissue injury, the physical signs are the limitation of activity and deformity of talocrural joint. The forced flexion of foot is the key point of diagnosis. Assistant examinations can be performed by means of imaging, arthroscopy and MR arthroscopy. The treatment is non-operatively （local external fixation, external compression, ultrasonic intermediate frequencymodulated electrotherapy, traditional medicine） and operation under arthroscope, and the newly emerged holmium laser makes the operation under arthroscope have more obvious advantages. CONCLUSION： The suitable therapeutic program is adopted by considering the characteristics of talocrural joint soft tissue injury and taking the early diagnosis as direction. The newly developed apparatus reduces the unnecessary operative therapy, but the best operative occasion and the best operative mean will decrease the damage by operation to the least.