踝关节镜前后联合入路治疗踝关节撞击综合征

Ankle arthroscopy for ankle impingement syndrome through anterior and posterior passage

目的 ：分析踝关节镜前后联合入路对踝关节撞击综合症患者镜下行清理的临床疗效及术中注意事项。方法：回顾性分析自2011年4月至2015年4月采用踝关节镜治疗并获得完整随访的17例踝关节撞击综合症患者,其中男12例,女5例;手术时年龄22~47岁,平均32.4岁。结合患者临床症状和影像学评估予踝关节镜清理,并去除引起症状的撞击部位,术后常规予非甾体消炎药和关节内注射透明质酸钠治疗。采用AOFAS（美国足踝外科协会）后足-踝评分,Ogilvie-Harris踝关节评分对术前情况及术后末次随访情况进行评分。结果：17例手术中情况：关节镜下显示前外踝撞击征8例,前内踝撞击征2例,前踝撞击征2例,后踝撞击征2例,3例为同时合并前后踝撞击。术中清除增生的骨赘,引起撞击的下胫腓前韧带远侧束,距腓前韧带,滑膜组织和疤痕组织。4例同时合并关节软骨损伤,软骨损伤面积约1 mm×3 mm至1.5 mm×4 mm大小。术中同时采用直径1.2 mm的克氏针行钻孔微骨折处理。17例术后随访时间8~24个月,平均14.3个月。AOFAS评分由手术前的62.30±5.20增加至术后的87.60±5.40。Ogilvie-Harris踝关节评分由手术前的6.70±0.98增加至术后的12.80±1.21。术后患者均无神经血管损伤,无伤口感染,愈合不良等并发症。患者有不同程度的踝关节肿胀,于术后4~8周逐步消失。结论：对踝关节撞击综合症患者,前后联合入路可以有效清除引起踝关节撞击的骨性撞击和软组织撞击,结合术后非甾体消炎药和关节内注射透明质酸钠治疗,可以有效缓解踝痛症状,达到较好的治疗效果。

Objective：To analyze clinical efficiency and intraoperative considerations of ankle arthroscopy for ankle impingement syndrome through anterior and posterior passage. Methods：From April 2011 to April 2015,the clinical data of17 patients diagnosed as ankle impingement syndrome were performed arthroscopy,including 12 males and 5 females,with an average age of 32.4 years（ranging from 22 to 47）. Ankle arthroscopy cleaning were carried out according to clinical symptoms and radiological imaging,crashed part were cleaned too. Non steroidal anti inflammatory drugs and intra articular injection of sodium hyaluronate were used as conventional postoperatively treatment. AOFAS score and Ogilvie-Harris score were used to assess preoperative situation and postoperative situation. Results：Intra operative conditions showed 8cases with anterior lateral impingement syndromes,2 cases with anterior medial impingement syndromes,2 cases with posterior impingement syndromes and 3 cases combined with anterior and posterior impingement syndromes. Distal bundle of anterior tibiofibular ligament,anterior talusfibular ligament and synovial tissue and scar tissue were cleared up during operation. Four patients were combined with concomitant articular cartilage injury,and damage area were about 1 mm×3 mm to1.5 mm×4 mm. Microfracture treatment were performed by 1.2 mm diameter Kirschner wire. All patients were followed up from 8 to 24 months with an average of 14.3 months. AOFAS score increased from 62.3±5.20 preoperatively to 87.6±5.40 postoperatively,Ogilvie-Harris ankle score increased from 6.70±0.98 preoperatively to 12.80±1.21 postoperatively. No neurovascular damage,wound infection or wound healing problem occurred. Ankle swelling were appeared with different degrees,but disappeared at 4 to 8 weeks postoperatively. Conclusion：For ankle impingement syndrome patients,ankle arthroscopy through anterior with posterior passage could effectively clear up bone and soft tissue impingement. Postoperatively non steroidal anti inflammatory drugs and intra articular injection of sodium hyaluronate could effectively relieve ankle pain and swollen and achieve good therapeutic effect.