俯卧位踝关节镜下前后外联合入路治疗后足大范围病变的临床应用

Clinical application of ankle arthroscopy in prone position through combined anterior⁃posterior⁃lateral approaches for extensive lesions of the hind foot

目的探讨采用俯卧位踝关节镜下前后外联合入路治疗后足大范围病变的临床疗效。方法回顾性分析2019年3月至2020年7月于我院骨科就诊的13例后足大范围病变病人(13足)的临床资料,按病种划分:踝关节滑膜炎合并距下关节炎5例,踝关节滑膜炎3例,距下关节炎合并跗骨窦综合征3例,踝关节感染2例。所有患足的病变范围均涉及后足的前方及后方,单纯前路或后路关节镜无法完全处理。所有病人术中采取俯卧位,先屈膝状态完成前路镜,如有必要,屈膝“4”字体位行跗骨窦清理,最后伸膝状态完成后路关节镜操作,必要时可行后路距下关节融合。观察并记录病人的手术时间、术中灌注水量、术后住院天数、术后并发症、手术前后的疼痛视觉模拟量表(visual analogue scale,VAS)评分。结果病人手术时间为(46.8±12.6)min,灌注水量为(6807.7±3827.2)ml,术后住院天数为(3.8±0.8)d。所有切口均一期愈合,1例发生跗骨窦血肿,加压包扎后按时愈合拆线,并发症发生率为7.7%(1/13)。VAS评分由术前(8.2±1.0)分降至术后(2.8±0.9)分,差异具有统计学意义(P<0.05)。随访期间未见感染、骨不连、畸形愈合等并发症。结论俯卧位关节镜可同时处理后足多个部位的病变,包括踝关节、距下关节及跗骨窦,微创化个性化治疗的同时,减少手术时间,缩短病人住院天数,节省病人治疗费用,是后足大范围病变可选择的治疗方式之一。

Objective To investigate the clinical effect of ankle arthroscopy in prone position through combined anterior⁃posterior⁃lateral approaches for extensive lesions of the hind foot.Methods The clinical data of 13 patients(13 feet)with extensive hind foot lesions from March 2019 to July 2020 in our hospital were retrospectively analyzed.Diseases included:5 cases of ankle synovitis with subtalar arthritis,3 cases of ankle synovitis,3 cases of subtalar arthritis with sinus tarsal syndrome,2 cases of ankle joint infection.All the lesions involved the front and back of the hind foot,which cannot be accessed by the unique anterior or posterior portal approach.During the operation,all patients were setup in the prone position,the knee was bent first to complete the anterior ankle arthroscopy,if necessary,the knee was bent in the“4”position to debride the sinus tarsal,and finally the knee was extended to complete the posterior arthroscopy.Subtalar joint arthrodesis was conducted when necessary.The operation time,intraoperative perfusion volume,postoperative hospital stay,complications,preoperative and postoperative visual analogue scale(VAS)scores were observed and recorded.Results The operation time was(46.8±12.6)min,perfusion volume was(6807.7±3827.2)ml,and postoperative hospital stay was(3.8±0.8)d.All incisions healed by first intention.One case had sinus tarsal hematoma,which was healed on time after pressure bandage.The incidence of complications was 7.7%(1/13).The VAS scores decreased from(8.2±1.0)points before surgery to(2.8±0.9)points after surgery,and the difference was statistically significant(P<0.05).During the follow⁃up period,no infection,nonunion,malunion or other complications were observed.Conclusion Ankle arthroscopy in the prone position can simultaneously treat the lesions of multiple areas of the hind foot,including the ankle joint,subtalar joint,and sinus tarsal.Minimally invasive and personalized treatment can reduce the operation time,shorten the hospital stay,and save the cost of patients,which is proved to be one of the options for treatment of extensive lesions of the hind foot.