青少年症状性腓下骨合并痛风性踝关节炎的手术治疗

Surgical treatment for symptomatic os subfibulare accompanied with gouty ankle arthritis in the teenagers

[目的]探讨青少年症状性腓下骨合并痛风性踝关节炎的手术疗效。[方法]回顾性分析2018年2月—2019年8月本科收治的症状性腓下骨合并痛风性踝关节炎15例患者的临床资料。男10例,女5例,左侧8例,右侧7例,年龄14~18岁,平均(15.73±1.03)岁。所有患者均采用踝关节镜下清理、腓下骨切除、Brostrom-Gould术联合人工线带加强修复距腓前初带。比较手术前后疼痛视觉模拟评分(visual analogue scale,VAS)和美国足踩外科协会(American Orthopedic Foor&Ankle Society,AOFAS)踝与后足评分。[结果]所有患者顺利完成手术,无神经、血管损伤等严重并发症,术后切口均一期愈合。15例患者获得随访,随访时间12〜18个月,平均(15.25±6.20)个月。术后VAS评分和A0FAS踝-后足评分均较术前明显改善,差异均有统计学意义(P<0.05)。[结论]对于症状性腓下骨合并痛风性踝关节炎患者,采用踝关节镜下清理、腓下骨切除、Brostrom-Gould术联合人工线带加强修复距腓前韧带,可以有效减轻症状,可早期开始踝关节的康复锻炼。

[Objective]To explore the clinical outcomes of combined surgical procedures for symptomatic os subfibulare with gouty ankle arthritis in the teenagers.[Methods]A total of 15 teenaged patients with symptomatic os subfibulare accompanied with gouty ankle arthritis underwent arthroscopic debridement,os subfibulare resection,and Brostrom-Gould procedure with Internal Brace to strengthen the repair of anterior talofibular ligament from February 2018 to August 2019.The patients included 10 males and 5 females,aged 14~18 years with a mean of(15.73±1.03)years.The VAS score and AOFAS score were used to evaluate the postoperative function of the ankle.[Results]All the patients had operation performed smoothly,without serious complications,and got incisions healed well.The followed up peri-od lasted for 12~18 months with a mean of(15.25±6.20)months.Compared with those preoperative,the VAS and AOFAS scores significant-ly improved at the latest follow-up.[Conclusion]For symptomatic os subfibulare with gouty ankle arthritis in the teenagers,arthroscopic debridement,os subfibulare resection,Brostrom-Gould procedure with Internal Brace artificial ligament to strengthen the repair of anterior talofibular ligament does effectively reduce the symptoms,and get early rehabilitation.