关节镜治疗踝关节撞击综合征的临床研究

Clinical study of the treatment on ankle Impingement syndrome with arthroscopy

目的：通过对关节镜治疗踝关节撞击综合征的临床病例进行分析,研究其对踝关节撞击综合征的治疗预后的作用,探究其诊断及治疗价值,为关节镜的临床应用提供依据。方法：回顾性的分析2011-01~2014-12我院2例及北京301医院21例关节镜治疗踝关节撞击综合征病例共23例,男15例,女8例,平均年龄（27±8.1）岁。23例患者均有运动扭伤踝关节病史。病程6~51月,平均（20±5.1）月。所有患者术前均进行X片检测正侧位踝关节、行MRI检查,排除踝关节严重病变病例。所有患者选择手术治疗前,进行3个月以上的保守治疗,包括制动、药物治疗等,均效果不佳。术中对增生滑膜组织进行清除,同时修整软骨及切除骨赘,去除游离体。所有患者均得到6个月完整随访。结果：1患者经术后随访查体,背伸及趾屈时,未见疼痛。踝关节的活动度基本恢复正常。18例（78.2%）患者关节疼痛完全缓解,2例活动时疼痛,3例活动后疼痛。所有患者术后关节肿胀缓解,活动能力显著提高。2患者术后6月AOFAS踝关节评分及迈斯林（Meislin）评估系统结果均提示,明显高于术前,差异具有统计学意义。3所有患者均未出现损伤神经血管的情况。手术切口均一期愈合,未见关节腔内感染。结论：关节镜治疗踝关节撞击综合征能够取得较好的临床疗效,镜下视野清晰,并且处理效果满意,创伤小,并发症少,功能恢复好。关节镜对踝关节撞击综合征的治疗是重要的临床应用。

Objective： To analyze the outcome of arthroscopy in the treatment of Ankle Impingement Syndrome by exploring the clinical cases with ankle impingement syndrome,and to provide more evidence to arthroscopy application. Methods： There were 23 patients accepting treatment on Ankle Impingement Syndrome with arthroscopy from January 2011 to December 2014,including 15 males and 8 females. The average age were（ 27 ± 8. 1） years.All patients had a medical history of Sports sprain,and took six to fifty-one months to cure the disease. X-ray examination and MRI were necessary before arthroscopy surgery in case of major injuries. Conservative treatment was carried out for 3-6 months before arthroscopy theatment,such as relaxation,immobilization and NASIDs drugs. Removing loose bodies,excision of osteophytes were conducted under arthroscopy during therapy. All patients owned a 6 months follow-up. Results： At first,Ankle motion of all patients recovered normally without pain during dorsal stretch and plantar lexion. In addition,the results of AOFAS score and eislin criteria significantly showed improvement before and after the treatment. There were no complication and intra-articular infection.What＇s more,one-stage healing was achieved in all patients. Conclusions： Arthroscopic treatment of ankle impingement can achieve good clinical outcome. And then,it was of small trauma,less complication and good function recovery when treated with arthroscopy.