前踝撞击征的关节镜下诊断与治疗

The diagnosis and treatment of anterior ankle impingement with arthroscopy

目的探讨前踝撞击征的关节镜下诊断与治疗。方法2000年1月至2006年1月，关节镜下治疗前踝撞击征患者28例，男18例，女10例；年龄18-51岁，平均32岁；左踝12例，右踝16例。17例有长期运动史，5例有踝关节背伸劳作史，6例有踝部骨折脱位史及反复损伤史；病史最短6个月，最长7年。踝关节检查时胫骨前缘或前内侧有固定压痛，背伸活动均不同程度受限，部分踝关节僵硬。根据Scranton和McDermott的放射学分级标准，Ⅰ级6例，Ⅱ级15例，Ⅲ级5例，Ⅳ级2例。术前采用McGuire踝关节评分系统进行评分，13例可（65-70分），15例差（〈65分）。最低41分，最高67分，平均52分。踝关节镜下用刨削器、磨钻、组织汽化仪等清理增生肥厚及炎性的滑膜、退变的软骨和骨赘等。结果所有患者均获随访，随访时间11-48个月，平均27个月。术后McGuire评分显示：Ⅰ级6例，均为优良。Ⅱ级15例，12例优良，3例可。Ⅲ级5例，2例优良，2例可，1例差；其中无间隙狭窄者2例，1例为优良，有间隙狭窄者3例，1例为优良。Ⅳ级2例，均为差。优良率为71．4％。术后最低59分，最高94分，平均76分，较术前平均提高24分。无一例发生并发症。1例Ⅳ级患者术后27个月复发。结论关节镜下治疗Ⅰ、Ⅱ级及部分无关节间隙狭窄的Ⅲ级前踝撞击征患者疗效肯定，而对于部分有关节间隙狭窄的Ⅲ级及Ⅳ级前踝撞击征患者疗效欠佳。

Objective To investigate the diagnosis and treatment of anterior ankle impingement syndromes. Methods The study reviewed 28 patients between January 2000 and January 2006, including 18 males and 10 females, left for 12 cases and right for 16 cases, with an average age of 32 years （range, 18-51 years）. All the patients were treated with arthroscopy. 17 patients had a long period history of exercises, 5 had a job involved excess dorsiflexion of the ankle, 6 had a history of fracture, dislocation and repeated damage of the ankle. The onset period was from 6 months to 7 years. The ankle joint examination showed fixed tendness at anterior or anteriorlateral tibia, limited dorsiflexion movement, and partial ankle stiffness. According to the radiologia criterion of Scranton and McDermott, there were 6 cases grade Ⅰ, 15 grade Ⅱ, 5 grade Ⅲ and 2 grade Ⅳ lesion. Preoperative evaluation with McGuire＇s scoring system rated fair for 13 cases （range, 65-70 points） and poor for 15 cases （〈 65 points）, with an average point of 52 （range, 41-67 points）. Treatment consisted of removalling of hyperplastic and pachyntic or inflame synovium, cataplasia cartilage and osteophyma with powered instruments, abrading auger or vaporization equipment. Resuits All patients were followed up for 11-48 （mean 27） months. The postoperative McGuire ratings were 6 excellent or good in 6 grad Ⅰ cases, 12 excellent or good and 3 fair in 15 grad Ⅱ cases, 2 excellent or good cases, 2 fair and 1 poor in 5 grad Ⅲ cases （including 1 excellent or good in 2 cases without narrowing of joint space, and 1 excellent or good in 3 cases with narrowing of joint space）, 2 poor in 2 grad Ⅳcases. The excellent and good rate was up to 71.4%. The average point was 76 （range, 59-94 points）, 24 points more than preoperative score, and there were no complications. Only 1 case encountered a recurrence in 27 months after arthroscopic surgery. Conclusion It＇s an effective method to treat anterior ankle impingement syndromes in grad Ⅰ , grade Ⅱ, and grade Ⅲ without narrowing of joint space cases using arthroscopy, but not for grade Ⅲ with narrowing of joint space cases and grad Ⅳ.