双排缝合桥固定技术治疗Haglund综合征的临床疗效分析

Clinical outcomes of double-row suture bridge fixation technique for Haglund syndrome

背景:保守治疗后疼痛症状缓解不明显的Haglund综合征患者可考虑手术治疗。缝合桥技术已广泛应用于肩袖损伤的修复。目的:评价双排缝合桥固定技术治疗Haglund综合征的临床疗效。方法:回顾性分析2013年6月至2016年7月,应用双排缝合桥固定技术治疗的22例(30足)Haglund综合征患者的病例资料。其中男13例(18足),女9例(12足),年龄22~48岁,平均(37.6±8.3)岁。术前主要临床表现为足跟后方疼痛及肿胀,跟腱止点及周边压痛,撞击试验阳性;负重位X线片见跟骨后上结节突起,超出平行间距线;MRI示跟腱末端病变及跟骨后滑囊炎。术中行跟腱止点病灶清除后使用双排缝合桥固定技术重建跟腱止点,术后定期随访。采用疼痛视觉模拟(VAS)评分,美国足踝外科协会(AOFAS)足踝功能评分、维多利亚运动学会跟腱(VISA-A)评分评估治疗结果。同时测量负重侧位X线片上跟骨倾斜角(CPA)、跟骨后角(FPA)、平行间距线(PPL)。结果:本组患者平均随访时间(38.9±9.2)个月,术后切口均一期愈合,随访期间无后跟肿胀、疼痛复发,无锚钉松动及移位、移植物取出、跟腱断裂等并发症发生。平均VAS评分、跟骨倾斜角、跟骨后角、平行间距线阳性率分别由术前的(5.1±1.2)分、18.6°±1.8°、72.9°±2.4°、100%减少为末次随访的(1.8±0.7)分、15.1°±2.1°、45.3°±5.0°、6.67%,差异均有统计学意义(P<0.01)。末次随访时AOFAS踝与后足评分、VISA-A跟腱评分较术前明显改善[(84.9±4.9)分vs(42.5±4.0)分,(88.7±6.0)分vs(47.6±4.2)分,P<0.01]。结论:双排缝合桥固定技术治疗Haglund综合征临床疗效良好,术中对病灶彻底清创、增加肌腱跟骨足迹及腱骨接触面积是影响手术疗效的关键。

Background: Surgical treatment may be considered for patients with Haglund syndrome who have no obvious pain relief after conservative treatment. Suture bridge technology has been widely used in the repair of rotator cuff injury. Objective:To evaluate clinical outcomes of double-row suture bridge fixation in the treatment of Haglund syndrome. Methods: Clinical data of 22 patients(30 feet) with Haglund syndrome treated by the double-row suture bridge fixation from June 2013 to July2016 were analyzed retrospectively. There were 13 males(18 feet) and 9 females(12 feet) with an average age of(37.6±8.3)years(range, 22-48 years). Preoperative clinical manifestations included posterior heel pain and swelling, local and peripheral tenderness of the Achilles tendon, and positive impact test. X-ray images of weight-bearing position showed a posterosuperior bony prominence of the calcaneus beyond the parallel pitch line. MRI showed insertional Achilles tendinitis and retrocalcaneal bursitis. After the surgical correction of Haglund deformity, the Achilles tendon insertion was reconstructed using the double-row suture bridge fixation technique. Clinical outcomes were assessed with visual analogue scale(VAS), AOFAS anklehindfoot scale, VISA-A scale, calcaneal pitch angle(CPA), Fowler-Philip angle(FPA) and parallel pitch line(PPI) during follow-up. Results: The mean follow-up period was(38.9±9.2) months(ranging from 22 to 51 months). The incision was healed well. No swelling or pain of the heel relapsed. No anchor loosening, displacement, removal, Achilles tendon rupture or other serious complications occurred. Compared with preoperative data, VAS score, CPA, FPA and PPL positive rate were significantly reduced at the final follow-up(5.1±1.2 vs 1.8±0.7, 18.6°±1.8° vs 15.1°±2.1°, 72.9°±2.4° vs 45.3°±5.0°, 100% vs 6.67%, P<0.01). The AOFAS Ankle-Hindfoot Scale and VISA-A scale at the last follow-up were significantly higher than preoperative ones(84.9±4.9 vs 42.5±4.0, 88.7±6.0 vs 47.6±4.2, P<0.01). Conclusions: The double-row suture bridge fixation can achieve good clinical outcomes in the treatment of Haglund syndrome. The thorough debridement of the Haglund deformity and the increase of the tendon and bone footprint as well as the contact area of tendon to bone are the key procedures for good curative effect of surgery.