关节镜治疗踝关节软组织撞击综合征的临床疗效观察

Clinical Efficacy of Arthroscope to Treat Soft Tissue Impingement Syndrome of Ankle

目的:探讨踝关节软组织撞击综合征(ASTIS)的临床特点以及关节镜手术治疗的疗效。方法:2005年9月-2010年4月,15例ASTIS损伤后(12～36个月)的患者,经踝关节镜探查手术,镜下切除撞击组织,术后采用AOFAS(美国足踝外科协会)后足-踝评分法评定手术效果。结果:关节镜下显示15例中:10例存在滑膜组织撞击;2例存在下胫腓前韧带损伤瘢痕组织撞击;3例存在半月板样组织撞击;12例合并关节软骨损伤。15例术后随访12～36个月,AOFAS主、客观评分术后较术前均明显提高,总体评分术前(65.3±8.4)分,术后(92.2±5.2)分,(P<0.05),主观评分术前(17.7±3.4)分,术后(32.5±5.7)分,(P<0.05)。结论:踝关节软组织撞击综合征多继发于踝关节内翻性损伤,临床常见,踝关节反复扭伤病史,发生部位以反复出现踝关节前外侧肿痛多见,撞击组织为滑膜、韧带及半月板样组织,较多病例同时合并关节软骨损伤,若长期非手术治疗效果不佳,采用关节镜治疗ASTIS效果满意。

Objective：To explore the clinical features and arthroscopic efficacy of soft tissue impingement syndrome of ankle（ASTIS）. Methods.. The impingement tissue of 15 cases with ASTIS （12 to 36 months） was resected by arthroseope from September 2005 to April 2010, and the effect of surgery was assessed by hind foot-ankle scoring of American OrthopedicFoot and Ankle Society （AOFAS）. Resuits：In 15 patients, ten with synovial tissue impingement, two with injury scar tissue impingement of tibiofibular ligament, three with meniscoid tissue impingement, and 12 with articular cartilage damage.All patients were followed up for 12 to 36 months. The main objective and subjective ratings of AOFAS were significantly improved after surgery （65.3 ± 8.4 points of preoperative VS 92.2 ± 5.2 points of postoperative in objective, P〈0.05,and 17.7 ± 3.4 points of preoperative VS 32.5 ± 5.7 points of postoperative in subjective, P 〈0.05）. Conclusion：The ASTIS is mostly secondary of the varus ankle injury. The ankle is commonly repeated sprains in clinic, and which locationto the anterolateral of the ankle joint. The impingement tissues are synovium, ligaments, and meniscus-like tissue, and cases are mainly concomitantly articular cartilage injury. Using arthroseope to treat ASTIS is effective if long-term non-surgical treatment was ineffective.