改良三入路全关节镜手术治疗Haglund综合征的疗效分析

Clinical efficacy analysis of a modified three-way arthroscopic treatment for Haglund syndrome

目的:探讨改良三入路全关节镜手术治疗Haglund综合征的临床疗效。方法:病例系列报告。纳入2017年2月—2020年3月徐州市中心医院足踝外科27例(35足)采用改良三入路全关节镜下治疗的Haglund综合征患者,其中男15例、女12例,年龄21~58(35.8±11.0)岁。观察患者的手术时间、术后住院时间、术后伤口愈合及并发症发生情况,术前及术后1年跟骨后角(FPA)、平行间距线(PPL);对比患者术前及术后6个月、1年患者踝关节疼痛视觉模拟评分法(VAS)评分、美国足踝外科协会(AOFAS)踝-后足评分;末次随访时根据AOFAS踝-后足评分评价患者的踝关节功能优良率。结果:患者手术均完成顺利,手术时间为19~68(35.0±15.3)min,术后住院时间3~5(3.9±0.8)d。术后患者切口均一期愈合,未出现伤口感染、神经损伤等并发症。患者术后均获随访,随访时间12~48(29.7±11.7)个月。末次随访时,FPA≥75°者由术前12足减少为1足;术后患足PPL均由术前的阳性转为阴性。术后6个月、1年,患者踝关节疼痛VAS评分分别为(1.77±0.73)、(1.49±0.61)分,AOFAS踝-后足评分分别为(83.40±5.44)、(86.66±6.28)分,均较术前的(6.46±1.27)、(61.00±10.20)分改善明显,差异均有统计学意义(F=325.00、118.30,P值均<0.05)。末次随访时,踝关节功能优15足、良20足,优良率为100%。结论:改良三入路全关节镜手术治疗Haglund综合征安全有效,具有切口小、手术时间短、术后可有效减轻踝关节疼痛和恢复踝关节功能的优势。

Objective This study aimed to explore the clinical efficacy of arthroscopic treatment for Haglund's syndrome using a modified triple portal approach.Methods It was a case series analysis comprising 27 cases(35 feet)of Haglund syndrome treated with arthroscopy using a modified triple portal approach in the Department of Foot and Ankle Surgery,Xuzhou Central Hospital from February 2017 to March 2020.The cohort consisted of 15 males and 12 females,aged 21 to 58(35.8±11.0)years.Surgical time,postoperative hospital stay,wound healing,and occurrence of complications were observed.Preoperative and postoperative 1-year follow-up evaluations included Fowler-Philip angle(FPA),parallel pitch line(PPL),ankle joint pain visual analog scale(VAS)scores,and American Orthopedic Foot and Ankle Society(AOFAS)ankle hindfoot scale at 6 months and 1 year postoperatively.The ankle joint function was evaluated on the basis of AOFAS scores at the final follow-up.Results All surgeries were successfully performed with a surgical time of 19 to 68(35.0±15.3)min and a postoperative hospital stay of 3 to 5(3.9±0.8)days.All incisions healed primarily without complications such as wound infection or nerve damage.Follow-up was conducted for all patients,with a follow-up time of 12 to 48(29.7±11.7)months.At the final follow-up,the number of feet with FPA≥75°decreased from 12 preoperatively to 1 postoperatively,and all feet exhibited negative PPL postoperatively compared with that preoperatively.At 6 months and 1 year postoperatively,the VAS scores were(1.77±0.73)and(1.49±0.61)points,respectively,and the AOFAS ankle hindfoot scale were(83.40±5.44)and(86.66±6.28)points,respectively,showing significant improvement compared with the preoperative scores of(6.46±1.27)and(61.00±10.20)points,with all differences being statistically significant(F=325.00,118.30;all P values<0.05).At the final follow-up,15 feet exhibited an excellent ankle joint function,and 20 feet exhibited a good result,leading to excellent and good rates of 100%.Conclusion Arthroscopic treatment of Haglund syndrome using a modified triple portal approach is safe and effective,offering advantages such as small incisions,short surgical time,and effective postoperative pain relief and restoration of the ankle joint function.