三入路关节镜技术治疗踝关节前外侧撞击征

Triple portals arthroscopic technique to treat anterolateral ankle impingement syndrome

目的探讨三入路关节镜技术治疗踝关节前外侧撞击征的临床疗效。方法常规建立前内侧、前外侧入路，然后建立前下外人路，通过这3个人路进行关节镜手术治疗躁关节前外侧撞击征26例。术后随访采用Meislin评分和美国足踝外科协会（AOFAS）踝关节评分系统。结果每例踝关节前外侧撞击征关节镜下可以发现以下1-5个病变：局限性滑膜炎、瘢痕组织增生、半月板样病变、距腓前韧带（ATFL）部分撕裂、前下胫腓联合韧带（AITFL）远侧束、骨赘、游离体、附属小骨、软骨损伤。其中最多的是软骨损伤（18例），其次是瘢痕组织增生（17例）和局限性滑膜炎（14例）。所有患者均获得18—36个月（平均24．5个月）随访，AOFAS评分术前为（70．3±8．2）分，末次随访时（92．0±5．3）分，t=11．3，P〈O．01；采用Meislin评分：优10例，良1l例。可5例，优良率8018％。’结论三人路关节镜技术能够到达前外侧沟的任何部位，可以明确诊断踝关节前外侧撞击征的病因，同时具有手术操作简单、安全性好、疗效佳的优点。

Objective To explore the results of triple portals arthroscopic technique to treat anterolateral ankle impingement syndrome. Methods Anteromedial and anterolateral portals were routinely treated, followed by an antero-inferior-lateral portal which was located under the anterior talofibular ligament and at the level of the tip of lateral malleolous. Through these three portals were all surgery performed. The follow-up was evaluated by Meislin scales and American Foot and Ankle Society Scores（AOFAS）. Results Every case of the anterolateral ankle impingement syndrome had I-5 lesions arthroscopically such as local synovitis, scarfing tissue proliferation, meniscus-like lesion, ATFL partial tear, distal fascicle of AITFL, osteophyte, loose body, accessory ossicle and Cartilage injury. Among them, cartllage injury （18 cases） was the most common findings followed by scarfing tissue proliferation （17 Cases） in the second place and local synovitis （14 cases） in the third place. All cases were followed-up for 18-36 months （mean, 24.5 months）. The AOFAS ankle scores were significantly improved from （70.3＋8.2） preoperatively to （92.0＋5.3） at the last visit（t =11.3, P 〈0.01 ）. According to Meislin scales, there were 10 excellent, 11 good and 5 fair cases and an excellent and good rate of 80.8% was achieved. Conclusion Triple portals ankle arthroscopic technique provides full access to every comer of the anterolateral gutter of the ankle joint and thus could establish a comprehensive pathological diagnosis for every anterolateral ankle impingement syndrome. In addition, it is technically simple, safe and effective.