距小腿（踝）关节软组织撞击综合征的功能重建

目的：距小腿（踝）关节软组织损伤是常见的运动损伤，影响日常生活和生活质量，危害性及早期诊断与治疗的重要性逐渐为医学界所重视．本文对长期以来学者们所做的大量研究进行综述，总结距小腿关节软组织撞击综合征的功能重建的最新进展。 资料来源：通过计算机检索Medline 1990-01／2004-12关于距小腿关节软组织撞击综合征的文献，检索词“Ankle Impingement syndrome，diagnosis，treatment”，限定语言种类为English。同时检索1990-01／2004-12中国全文期刊数据库有关距小腿关节软组织撞击综合征的文献，检索词：“踝关节；踝损伤；踝外侧韧带”，限定语言种类为中文。 资料选择：选择与距小腿关节软组织损伤相关的观察对比研究、经验总结、个案报告等文献，检索该最新的研究进展，力求资料全面。排除重复性研究。 资料提炼：共收集有关距小腿关节软组织损伤相关的文献40篇，排除重复性研究13篇。纳入27篇。其中有关距小腿关节软组织撞击综合征的定义2篇，关于其诊断10篇，关于其治疗14篇，关于其新发展1篇。 资料综合：距小腿关节无骨折脱位的长期肿痛称为距小腿关节软组织撞击综合征。发病机制为距小腿关节周围组织损伤，体征表现为距小腿关节活动受限，畸形。脚底被迫屈曲状态是诊断的关键。辅助检查可通过影像学，关节镜检查，MR关节造影术进行。其治疗采用非手术治疗（局部外固定，外敷，超声中频调制电疗法，传统医学）和关节镜下手术治疗，新出现的钬激光使距小腿关节镜手术有更明显优势。 结论：结合距小腿关节软组织损伤的特点，以早期诊断为方向，选用适宜的治疗方案，开发新的仪器减少不必要的手术治疗，但同时应寻找最佳的手术时机，研究最佳的手术方式，将手术的损伤减到最低。     

踝关节镜下距腓前韧带重建联合内固定治疗旋后内收Ⅱ度踝关节损伤的临床疗效

[目的]探讨踝关节镜下距腓前韧带重建联合内固定治疗旋后内收Ⅱ度踝关节损伤的临床疗效.[方法]回顾性分析2014年1月至2018年6月在本院诊治的102例旋后内收Ⅱ度踝关节损伤患者,按照治疗方法不同分为观察组(踝关节镜下距腓前韧带重建联合支撑钢板内固定)和对照组(切开复位联合支撑钢板内固定),每组51例.比较两组围手术期...     

电脑中频对距小腿关节及周围软组织运动损伤的疗效

目的采用中医疗法并电脑中频治疗距小腿关节及周围软组织运动损伤,探讨其康复疗效。方法根据损伤轻重将66例学生分为两组,损伤轻者为对照组33例,损伤重者为治疗组33例。对照组只采用综合治疗,而治疗组在综合治疗基础上加用中频治疗,所有患者均在治疗15d后评定疗效。结果治疗后对照组治愈率18%,有效率73%,治疗组治愈率70%,有效率97%,两组之间差异有显著性意义(χ2=7.542,P<0.05)。结论采用中医疗法并电脑中频治疗距小腿关节及周围软组织运动损伤疗效显著,可缩短疗程。     

跨栏运动员距小腿关节损伤的特征、治疗及成因分析

跨栏是运动员在高速度奔跑途中连续跨越数个固定高度栏架障碍的运动。在田径项目中技术最复杂、身体素质要求高,由于专项技术的复杂性、特殊性而引发的距小腿(踝)关节损伤有显著增多,因此,了解造成损伤部位的解剖结构特征,弄清专项技术的特殊要求与损伤的关系,从而开展有针对性的防治,将有助于跨栏教学训练任务的完成。     

距小腿关节运动损伤的常见因素

距小腿关节是人体中比较复杂和重要的关节,发生损伤的几率很高。对于距小腿关节损伤,虽然多数人通过治疗可以康复,但仍有20%左右的患者将转为慢性损伤或伤残。有鉴于此,探讨距小腿关节损伤的机制、找出距小腿关节损伤的原因及掌握预防的措施,是体育教学、运动训练和大众体育活动中迫切需要解决的问题。     

河图洛书推足面筋手法治疗距小腿关节损伤

据有关学者研究表明运动性损伤部位以踝、足、膝受伤率最高,分别为23.0%,19.6%,16%,其次是手腕和肩部。这表明运动创伤主要分布在上、下肢的关节部位,特别是踝部创伤率最高。对距小腿关节(踝关节)运动损伤采用常规性和传统的中医手法,如冷敷、热敷、针灸、拔罐、推拿按摩等,一般需2～3周方可恢复(但个别仍不能痊愈)。采用河图洛书推足面筋手法,经过两年多的临床实践与研究,尤其对体育专业师生距小腿关节运动损伤,进行了跟踪治疗观察,作了详细记录,对收治的38例距小腿关节扭伤者,均取得良好疗效。     

体育课中的距小腿关节扭伤

距小腿(踝)关节扭伤是体育课中常见的运动损伤,研究其发病机制、伤后处理、治疗等,并提出预防距小腿关节扭伤的具体方法,以保证体育课的教学质量得到不断提高。     

膝、距小腿关节运动损伤的调查分析

采用问卷调查结合访谈方法,以潍坊学院体育系2000级、2001级的学生为对象,对运动中膝、距小腿关节(踝关节)运动损伤的原因及预防的措施等进行了研究,并提出了科学合理的方法和建议,旨在引起对膝、距小腿关节运动损伤防护的重视,以减少发病率。     

重度创伤性距小腿关节僵直的Ilizarov外固定技术治疗

目的:探讨应用Ilizarov外固定技术治疗重度创伤性距小腿(踝)关节僵直的方法与疗效。方法:选择2002-08/2004-10在解放军总医院骨科用Ilizarov距小腿关节牵伸器治疗重度创伤性距小腿关节僵直7例,入院前均因创伤在外院接受过各种手术治疗,术后出现严重的距小腿关节跖屈僵直。经平均7个月(5～14个月)的功能锻炼和物理治疗后无明显好转,其中男5例,女2例,年龄16～42岁,平均27岁。手术时先将预先组装好的距小腿关节牵伸器套在小腿与足部,牵伸器的铰链式关节对准距小腿关节的关节间隙,在小腿和足部各穿2组克氏针与牵伸器的钢环固定。术后4d开始调整牵伸杆,直至距小腿关节达到中立位,并在此位置维持4周。带架时间8～14周,平均10周。所有患者术后观察时间为4～24个月,平均10个月。结果:7例患者全部进入结果分析。①距小腿关节平均保持在跖屈3°位置,较术前平均改善43°,距小腿关节活动范围平均为18°,比术前平均进步12°。②除1例需穿矫形鞋行走外,其余6例都能正常行走,步态明显改善,无足踝疼痛。小腿的周径较术前明显增加,外观丰满,肌力增强。③1例患者在牵伸过程中出现屈趾畸形,经肌腱延长手术后消失。无严重并发症,行走功能明显改善。结论:Ilizarov外固定技术治疗重度创伤性距小腿关节僵直,能够避免一次性跟腱延长术可能出现的距小腿关节后部跟腱外的皮肤缺损,组织损伤小与并发症少。     

足踝部皮肤软组织缺损游离皮瓣修复

目的:探讨应用游离皮瓣移植修复足踝部皮肤软组织缺损的临床效果及预后.方法:应用股前外侧皮瓣、小腿外侧皮辫游离移植修复足踝部皮肤软组织缺损,切取的皮瓣面积12 cm×8 cm～20 cm×13 cm,供区中厚或全厚皮片植皮修复.结果:19例踝周皮肤软组织缺损行游离皮瓣移植全部成活,1例在皮瓣修复的周围软组织挫伤区出现坏死、二期行膝内侧交腿皮瓣修复.术后随访6～12个月,皮瓣多显臃肿,4例行二期修整,无渍疡发生,感觉部分恢复,功能恢复良好.结论:在踝周无合适局部皮瓣或带蒂皮瓣转移修复的情况下,依据软组织缺损情况采用不同的游离皮瓣修复方法,可达到较好的外观和功能要求.     

The effect of talocrural joint manipulation on range of motion at the ankle

OBJECTIVE: To determine whether a single high-velocity, low-amplitude thrust manipulation to the talocrural joint altered ankle range of motion. DESIGN: A randomized, controlled and blinded study. SUBJECTS: Asymptomatic male and female volunteers (N = 41). METHODS: Subjects were randomly assigned into either an experimental group (n = 20) or a control group (n = 21). Both ankles of subjects in the experimental group were manipulated by using a single high-velocity, low-amplitude thrust to the talocrural joint. Pretest and posttest measurements of passive dorsiflexion range of motion were taken. RESULTS: No significant changes in dorsiflexion range of motion were detected between manipulated ankles and those of control subjects. A significantly greater pretest dorsiflexion range of motion existed in those ankles in which manipulation produced an audible cavitation. CONCLUSION: Manipulation of the ankle does not increase dorsiflexion range of motion in asymptomatic subjects. Ankles that displayed a greater pretest range of dorsiflexion were more likely to cavitate, raising the possibility that ligament laxity may be associated with the tendency for ankles to cavitate.     

Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain

Restrictions in ankle dorsiflexion range of motion (ROM) have been associated with decreased posterior talar glide in individuals with an acute lateral ankle sprain. Talocrural joint mobilizations may be used to restore joint arthrokinematics. Our purpose was to examine the effects of a single bout of anterior to posterior (AP) talocrural joint mobilization on self-reported function, dorsiflexion ROM, and posterior talar translation in individuals with an acute lateral ankle sprain. This single-blinded, randomized controlled trial utilized 17 volunteers (nine treatment and eight control) with an acute lateral ankle sprain (grade I/II) who were immobilized for a period of 1–7 days. The treatment group received a single 30-second bout of grade III AP talocrural joint mobilization the day their immobilization device was removed, while the control group did not receive any intervention. Active dorsiflexion ROM and posterior talar translation were assessed before, immediately after, and 24 hours after receipt of the treatment or control interventions. Self-reported function and pain were assessed before and 24 hours after the receipt of the treatment or control interventions using the foot and ankle disability index. Collectively all groups demonstrated improved dorsiflexion ROM and self-reported function. There was a significant decrease in pain perception at 24-hour follow-up for the treatment group. A single bout of AP talocrural joint mobilizations may not have an immediate effect on ankle dorsiflexion ROM, posterior talar translation, or self-reported function; however, they may have an immediate effect on pain perception in individuals with an acute lateral ankle sprain.     

The incidence of recurrent soft tissue ankle injuries

A prospective study was carried out to assess the incidence of recurrent soft tissue injuries to the ankle joint. Out of 310 patients with acute ankle injuries seen in the accident and emergency department at the Royal Victoria Infirmary, Newcastle upon Tyne, 101 (32.5%) had injuries which were severe enough to necessitate review in the follow-up clinic. Twenty-seven of these patients (26.7%) had sustained one or more previous injuries to the same ankle within the past 24 months. This rather high incidence of recurrence highlights the need to evaluate our current diagnostic and treatment policies in dealing with this common injury.     

Functional measurement of knee joint position sense after anterior cruciate ligament reconstruction

OBJECTIVE: To examine for differences in joint position sense (JPS) between knees with reconstructed anterior cruciate ligaments (ACLs) and uninjured knees by using a functional weight-bearing measurement method. DESIGN: Two-way repeated-measures in a convenience sample. SETTING: An Australian university rehabilitation laboratory. PARTICIPANTS: Nine subjects presenting at 12 to 16 months after unilateral ACL reconstruction using the semitendinosus/gracilis graft who were recruited from 2 orthopedic surgeons. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: JPS of the reconstructed and uninjured knees was examined by using the Peak Motus motion measurement system to record target joint angles and to calculate reproduced angles after limb movement into flexion and extension, performed in a weight-bearing position. RESULTS: There were no significant differences in JPS between reconstructed and uninjured knees (P=.68) or between the flexion and extension tasks (P=.47). CONCLUSION: There was no deficit in knee JPS 12 to 16 months after ACL reconstruction, as measured by a functional weight-bearing method. Further studies should examine the clinical utility of the method as a way to evaluate functional aspects of knee joint proprioception.     

重视踝关节损伤后重建,减少疼痛等并发症

1938年，中国当时的《外科学报》报道三关节融合术，可能是我国踝足外科发展的起点。历经70年，足踝外科在创伤重建、畸形和脊髓灰质炎后遗症矫治、踝足部矫形康复等方面，改良或创新了很多种手术和方法。随着经济社会的发展，足踝损伤的发病率越来越高，患者对足踝损伤后的重建要求越来越高。我国足踝外科目前呈现快速发展的状况，踝足外科临床工作和基础研究的广泛开展及疗效的提高     

Arthroscopic debridement: effective treatment for impingement after total ankle arthroplasty

Total ankle arthroplasty has been gaining significant popularity for the treatment of ankle arthritis. Subsequent rates of revision surgery secondary to symptomatic bony impingement have been reported in 6–45 % of cases. Arthroscopic debridement of bony impingement following total ankle has been recently reported as an effective therapy. An arthroscopic technique has been recently published by one of the senior authors. In this paper, we expand this technique and retrospectively review our experience with arthroscopic debridement of twenty ankles in twenty patients with symptomatic bony impingement following total ankle arthroplasty.     

足踝部软组织缺损的组织修复

Background: Injury of soft tissue at foot and ankle region is often complicated with dysfunction.Selecting of rational repair method has an important significance to patients' function recovery.