关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征

ARTHROSCOPIC THERAPY OF ANKLE JOINT IMPINGEMENT SYNDROME AFTER OPERATION OF ANKLE JOINT FRACTURE DISLOCATION

目的探讨关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征的方法及疗效。方法 2008年3月-2010年4月,收治38例踝关节骨折脱位术后发生踝关节撞击综合征的患者。男28例,女10例;年龄18～42岁,平均28岁。患者内固定术后至该次入院时间为12～16个月,平均13.8个月。踝关节前外侧和前侧有局限性压痛;关节背伸—20～—5°,平均—10.6°;跖屈30～40°,平均35.5°。根据美国矫形足踝协会(AOFAS)踝与后足评分标准,总分为(48.32±9.24)分,疼痛评分为(7.26±1.22)分。X线片检查示胫骨前缘和距骨均有骨赘增生,MRI显示22例有胫、距关节软骨面损伤。关节镜下行胫骨前缘或距骨骨赘磨削,刨削清理前外踝的瘢痕和增生滑膜组织,清除剥脱软骨;其中22例胫、距关节软骨面损伤者行微骨折术治疗。结果术后患者切口均Ⅰ期愈合。38例均获随访,随访时间10～26个月,平均16个月。末次随访时,26例踝关节活动基本恢复正常,背伸达15～25°,平均19.6°;跖屈35～45°,平均40.7°。8例轻度受限,背伸5～15°,平均7.2°;跖屈35～45°,平均39.5°。4例持续行走3～4 h后踝关节出现疼痛,关节活动轻度受限,背伸0～5°,平均2.6°;跖屈35～40°,平均37.5°。AOFAS踝与后足评分总分为(89.45±9.55)分,与术前比较差异有统计学意义(t=21.962,P=0.000);疼痛评分为(1.42±1.26)分,与术前比较差异有统计学意义(t=16.762,P=0.000)。结论关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征手术操作简便,可获得较好疗效。

Objective To study the operative procedure and the effectiveness of arthroscopic therapy for ankle joint impingement syndrome after operation of ankle joint fracture dislocation. Methods Between March 2008 and April 2010, 38 patients with ankle joint impingement syndrome after operation of ankle joint fracture dislocation were treated. Among them, there were 28 males and 10 females with an average age of 28 years （range, 18 to 42 years）. The time from internal fixation to admission was 12-16 months （mean, 13.8 months）. There were pressing pain in anterolateral and anterior ankle. The dorsal extension ranged from -20 to -5° （mean, 10.6°）, and the palmar flexion was 30-40° （mean, 35.5°）. The total score was 48.32 ±9.24 and the pain score was 7.26±1.22 before operation according to American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hindfoot score system. The X-ray films showed osteophyte formation in anterior tibia and talus; MRI showed cartilage injury in 22 cases. Arthroscopic intervention included removing osteophytes, debriding fabric scars and synovial membrane tissues, and removing osteochondral fragments. Arthroscopic microfracture technique was used in 22 patients with cartilage injury. Results All incisions healed primarily. Thirty-eight cases were followed up 10-26 months （mean, 16 months）. At last follow-up, 26 patients had normal range of motion （ROM）; the dorsal extension was 15-25°（mean, 19.6°） and the palmar flexion was 35-45° （mean, 40.7°）. Eight patients had mild limited ROM; the dorsal extension was 5-15° （mean, 7.2°） and the palmar flexion was 35-45° （mean, 39.5~）. Four patients had mild limited ROM and pain in posterior portion of the ankle after a long walking （3-4 hours）; the dorsal extension was 0-5° （mean, 2.6°） and the palmar flexion was 35-40° （mean, 37.5°）. The total score was 89.45 ± 9.55 and the pain score was 1.42 ± 1.26 after operation according to AOFAS ankle and hindfoot score system, showing significant differences when compared with preoperative ones （t=21.962, P=0.000; t=16.762, P=0.000）. Conclusion Arthroscopic treatment of ankle joint impingement syndrome after operation of ankle joint fracture dislocation is an effective, simple, and safe method.