全镜下跟腱清理与止点增强治疗跟腱部分撕裂的Haglund综合征的疗效对比

目的 比较全关节镜下跟腱清理与跟腱止点增强重建治疗跟腱部分撕裂的Haglund综合征患者的临床疗效。方法 回顾性分析2016年1月至2021年3月在青县人民医院应用全关节镜下治疗跟腱部分撕裂的Haglund综合征的24例患者资料，依据手术方式不同分为关节镜下跟腱止点清理组（A组）和关节镜下跟腱止点清理+跟腱止点增强重建组（B组），每组各12例。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）足踝功能评分及维多利亚体育研究所评分（VISA-A）评估治疗结果，进行观察对比。结果 患者平均随访时间（7.5±0.8）个月，末次随访均不存在后足跟肿痛、跟腱再次断裂等并发症。所有患者症状较术前均得到缓解。A组和B组的VAS评分、AOFAS评分、VISA-A评分均较术前有所改善；然而A组和B组术前及术后6个月的VAS、AOFAS、VISA-A评分对比，差异无统计学意义（P＞0.05）；B组术后1、3个月的VAS、AOFAS、VISA-A评分优于A组，差异有统计学意义（P＜0.05）。结论 全关节镜下跟腱止点增强重建治疗跟腱部分撕裂的Haglund综合征，较关节镜下单纯跟腱止点清理患者恢复更快，值得临床推广。

Comparison of the efficacy of total arthroscopic Achilles tendon cleaning and enhanced Achilles insertion in Haglund syndrome with partial Achilles tendon tears

Objective To compare the clinical efficacy of total arthroscopic Achilles tendon debridement and enhanced Achilles insertion reconstruction in Haglund syndrome patients with partial Achilles tendon tears.Methods Retrospective analysis was performed on the data of 24 cases of Haglund syndrome with partial Achilles tendon tear treated under total arthroscopy in Qingxian People''s Hospital from January 2016 to March 2021. According to different surgical methods, the patients were divided into arthroscopic Achilles tendon insertion cleanup group (group A) and arthroscopic Achilles tendon insertion cleanup + Achilles tendon insertion enhancement reconstruction group (group B), with 12 cases in each group. After regular follow-up, visual analogue pain (VAS) score, American Association of Foot and Ankle Surgery (AOFAS) foot and ankle function score and Victoria Institute of Sport (VISA-A) score were used to evaluate the treatment results.Results The mean follow-up time of the patients was (7.5±0.8) months, and there were no complications such as heel swelling, pain and re-rupture of Achilles tendon at the last follow-up. All patients had improved symptoms compared with those before surgery. The VAS score, AOFAS score and VISA-A score of group A and group B were improved compared with those before surgery. However, there was no significant difference in VAS, AOFAS and VISA-A scores before and 6 months after surgery between group A and group B (P>0.05). The VAS, AOFAS and VISA-A scores of group B 1 and 3 months after surgery were better than those of group A, and the differences were statistically significant (P<0.05).Conclusion Enhanced reconstruction of Achilles tendon insertion under total arthroscopy for Haglund syndrome with partial Achilles tendon tear has a faster recovery and better effect than pure Achilles tendon insertion removal under arthroscopy, which is worthy of clinical promotion.