青少年距骨前外侧副关节致疼痛性距跟撞击的诊断与治疗

The diagnosis and treatment of painful impingement of accessory anterolateral talar facet in adolescents

目的探讨距骨前外侧副关节致疼痛性距跟撞击的诊断、治疗和短期预后。方法回顾性分析中国医科大学附属盛京医院收治的3例(4足)距骨前外侧副关节致疼痛性距跟撞击患者的病历资料。3例患者均为男性,年龄13～15岁,BMI为21.8～24.2 kg/m2。平均发病至就诊时间为1年。纳入标准:(1)腓骨肌痉挛性僵硬性扁平足,无外伤史,无跗骨联合,跗骨窦区压痛(+)。(2)CT或MRI证实距骨前外侧副关节与距骨后关节表面连续。(3)MRI示距骨前外侧副关节周围距骨和跟骨颈部水肿。3例(4足)均行距骨前外侧副关节切除术,其中1足联合腓骨短肌延长,1足联合腓骨短肌移植至腓骨长肌。结果随访时间为6个月～2年。术后疼痛症状消失。美国足踝外科学会(AOFAS)后足评分由术前的48～76分,提高至术后的79～91分。但患者主观仍感觉患足灵活度欠佳。结论青少年腓骨肌痉挛性僵硬性平足,尤其合并跗骨窦区疼痛,要考虑距骨前外侧副关节致疼痛性距跟撞击的可能,同时需排除跗骨联合。患足MRI有助于诊断。采用距骨前外侧副关节切除术短期疗效良好。

Objective To introduce the diagnosis’treatment and the short-term outcome of the operative treatment of painful impingement of accessory anterolateral talar facet. Methods Three male patients with 4 affected feet were treated operatively in the Shengjing Hospital of China Medical University. They aged 13 to 15 years and had BMI between 21 .8 and 2 4 .2 kg/m2. There was on average a one-year elapse between the onset of the symptoms and the hospital visit. The inclusion criteria were （Dperoneal spastic flatfeet presented with tenderness in the sinus tarsi but without traumatic histories and tarsal coalition ; （2） continuity between the artic-ular surface of the posterior facet of the talus and the accessory anterolateral talar facet determined by CT or MRI ; focal bone marrow edema of the talus and calcaneal neck nearby confirmed by MRI. All the patients were treated with excision of the accessory facet. Lengthening of the musculi peronaeus brevis was performed in one foot and transference of the musculi peronaeus brevis to the musculi peronaeus longus was done in another.Results Three patients were followed up from 6 months to 2 years. Pain disappeared after operation and func-tional restoration was significant. The AOFAS hindfoot scores increased from 48-76 points to 79-91 points. How-ever, the patients still felt inadequate flexibility of the affected foot. Conclusion For adolescent peroneal spastic flatfeet, especially when accompanied by pain in the sinus tarsi, impingement of the accessory anterolat-eral talar facet should be suspected while excluding tarsal coalition. MRI of the affected foot facilitats the diag-nosis. Excision of the accessory anterolateral facet yields a good short-term outcome.