踝关节前外侧软组织撞击综合征的关节镜下诊断和治疗

目的 探讨踝关节前外侧软组织撞击综合征的关节镜下诊断和治疗.方法 对50例临床疑似踝关节前外侧软组织撞击综合征者行关节镜检查,确诊并行关节镜下清理术者40例.对诊断和治疗结果进行回顾性总结分析.结果 术前确诊率为80%,40例均获随访,随访时间平均18个月.术后优16例,良18例,可6例,优良率85%.结论 踝关节镜对踝关节前外侧软组织撞击综合征的诊断和治疗有重要价值.     

关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征

目的探讨关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征的方法及疗效。方法 2008年3月-2010年4月,收治38例踝关节骨折脱位术后发生踝关节撞击综合征的患者。男28例,女10例;年龄18～42岁,平均28岁。患者内固定术后至该次入院时间为12～16个月,平均13.8个月。踝关节前外侧和前侧有局限性压痛;关节背伸—20～—5°,平均—10.6°;跖屈30～40°,平均35.5°。根据美国矫形足踝协会(AOFAS)踝与后足评分标准,总分为(48.32±9.24)分,疼痛评分为(7.26±1.22)分。X线片检查示胫骨前缘和距骨均有骨赘增生,MRI显示22例有胫、距关节软骨面损伤。关节镜下行胫骨前缘或距骨骨赘磨削,刨削清理前外踝的瘢痕和增生滑膜组织,清除剥脱软骨;其中22例胫、距关节软骨面损伤者行微骨折术治疗。结果术后患者切口均Ⅰ期愈合。38例均获随访,随访时间10～26个月,平均16个月。末次随访时,26例踝关节活动基本恢复正常,背伸达15～25°,平均19.6°;跖屈35～45°,平均40.7°。8例轻度受限,背伸5～15°,平均7.2°;跖屈35～45°,平均39.5°。4例持续行走3～4 h后踝关节出现疼痛,关节活动轻度受限,背伸0～5°,平均2.6°;跖屈35～40°,平均37.5°。AOFAS踝与后足评分总分为(89.45±9.55)分,与术前比较差异有统计学意义(t=21.962,P=0.000);疼痛评分为(1.42±1.26)分,与术前比较差异有统计学意义(t=16.762,P=0.000)。结论关节镜下治疗踝关节骨折脱位术后踝关节撞击综合征手术操作简便,可获得较好疗效。     

踝关节软组织撞击综合征的关节镜治疗

目的总结踝关节软组织撞击综合征(ankle soft tissue imp ingem ent syndrom e,ASTIS)的临床和病理特点以及关节镜手术治疗的效果。方法2000年11月~2005年4月,21例ASTIS伤后1~48个月,(13.6±9.9)月接受关节镜手术,镜下切除撞击组织,并进行病理检查。术后采用AOFAS(美国足踝外科协会)后足-踝评分法评定手术效果。结果关节镜下显示20例存在滑膜组织撞击(14例合并以下其他组织撞击),下胫腓前韧带远侧束撞击5例、纤维瘢痕组织撞击4例、距腓前韧带组织撞击3例和半月板样组织撞击3例。16例合并关节软骨损伤。21例术后随访7~60个月,(34.3±9.4)月,AOFAS主客观评分术后较术前均明显提高,总体评分术前(67.0±9.7)分,术后(94.0±6.4)分(t=-7.205,P=0.000),主观评分术前(20.7±6.6)分,术后(35.7±4.9)分(t=-5.003,P=0.000)。结论踝关节软组织撞击综合征多继发于踝关节创伤。发生部位以踝关节前外侧更多见。撞击组织为滑膜、韧带、瘢痕组织及半月板样组织。关节镜治疗ASTIS效果满意。     

踝关节软组织撞击综合征的诊断和治疗

目的 探讨踝关节软组织撞击综合征的诊断和治疗。方法 1995年3月～2001年5月，我科共收治踝关节软组织撞击综合征36例。其中经MRI检查后行踝关节切开嵌夹软组织切除术14例，关节镜检查及镜下切除嵌夹软组织22例。结果 随访36例，时间6月～7年，平均22月，优9例，良19例，可7例，差1例，优良率77．8％(28／36)。结论 关节镜检查及镜下手术是治疗踝关节软组织撞击综合征有效方法。     

踝关节镜前后联合入路治疗踝关节撞击综合征

目的 :分析踝关节镜前后联合入路对踝关节撞击综合症患者镜下行清理的临床疗效及术中注意事项。方法:回顾性分析自2011年4月至2015年4月采用踝关节镜治疗并获得完整随访的17例踝关节撞击综合症患者,其中男12例,女5例;手术时年龄22~47岁,平均32.4岁。结合患者临床症状和影像学评估予踝关节镜清理,并去除引起症状的撞击部位,术后常规予非甾体消炎药和关节内注射透明质酸钠治疗。采用AOFAS(美国足踝外科协会)后足-踝评分,Ogilvie-Harris踝关节评分对术前情况及术后末次随访情况进行评分。结果:17例手术中情况:关节镜下显示前外踝撞击征8例,前内踝撞击征2例,前踝撞击征2例,后踝撞击征2例,3例为同时合并前后踝撞击。术中清除增生的骨赘,引起撞击的下胫腓前韧带远侧束,距腓前韧带,滑膜组织和疤痕组织。4例同时合并关节软骨损伤,软骨损伤面积约1 mm×3 mm至1.5 mm×4 mm大小。术中同时采用直径1.2 mm的克氏针行钻孔微骨折处理。17例术后随访时间8~24个月,平均14.3个月。AOFAS评分由手术前的62.30±5.20增加至术后的87.60±5.40。Ogilvie-Harris踝关节评分由手术前的6.70±0.98增加至术后的12.80±1.21。术后患者均无神经血管损伤,无伤口感染,愈合不良等并发症。患者有不同程度的踝关节肿胀,于术后4~8周逐步消失。结论:对踝关节撞击综合症患者,前后联合入路可以有效清除引起踝关节撞击的骨性撞击和软组织撞击,结合术后非甾体消炎药和关节内注射透明质酸钠治疗,可以有效缓解踝痛症状,达到较好的治疗效果。     

Scranton Ⅰ、Ⅱ度踝关节软组织撞击综合征的关节镜下治疗

目的 评估关节镜下治疗Scranton Ⅰ、Ⅱ度踝关节软组织撞击综合征的方法与疗效.方法 采用关节镜下治疗Scranton Ⅰ、Ⅱ度踝关节软组织撞击综合征17例,镜下刨削切除撞击组织,修整关节软骨,1例为距骨前外侧软骨Ⅳ度损伤,行软骨下骨微骨折术.结果 本组随访12～30个月,应用改良Mcguire踝关节评分,由术前平均60分提高至术后平均91分(P＜0.05).术后按Liu等踝关节功能分级标准:0级15例,1级1例,2级1例（即软骨Ⅳ度损伤患者）.结论 关节镜辅助治疗ScrantonⅠ、Ⅱ度踝关节软组织撞击综合征创伤小、恢复快,是一种有效的方法.     

ScrantonⅠ、Ⅱ度踝关节软组织撞击综合征的关节镜下治疗

目的评估关节镜下治疗ScrantonⅠ、Ⅱ度踝关节软组织撞击综合征的方法与疗效。方法采用关节镜下治疗ScrantonⅠ、Ⅱ度踝关节软组织撞击综合征17例,镜下刨削切除撞击组织,修整关节软骨,1例为距骨前外侧软骨Ⅳ度损伤,行软骨下骨微骨折术。结果本组随访12-30个月,应用改良Mcguire踝关节评分,由术前平均60分提高至术后平均91分（P〈0．05）。术后按Liu等踝关节功能分级标准：0级15例,1级1例,2级1例（即软骨Ⅳ度损伤患者）。结论关节镜辅助治疗ScrantonⅠ、Ⅱ度踝关节软组织撞击综合征创伤小、恢复快,是一种有效的方法。     

踝关节撞击综合征诊断和治疗

踝关节撞击综合征主要表现为踝关节慢性疼痛,过度活动时疼痛加剧.其病因主要为反复微创伤所致软骨损伤,引起滑膜炎性增生和骨赘产生,关节活动时增生的滑膜嵌入骨赘中而产生挤压疼痛.诊断主要通过体格检查和影像学检查.近年治疗方法主要为踝关节镜手术,清除增生的炎性组织及骨赘,达到治疗目的.与传统手术治疗相比,踝关节镜手术具有创伤小...     

踝关节撞击征的关节镜治疗分析

目的 探讨关节镜下治疗踝关节撞击衍的疗效.方法 对2005年3月至2008年9月收治的23例关节镜下确诊为踝关节撞击征患者进行关节镜下治疗,其中男16例,女7例;年龄16～49岁,平均29岁.比较手术前后美国足踝外科协会(AOFAS)踝与后足评分.结果 本组23例患者均获随访,时间9～36个月,平均25个月.术后AOFAS平均评分[(81.6±8.1)分]明显高于术前评分[(54.2±6.4)分],差异有统计学意义(t=2.015,P=0.000).13例患者可恢复至其之前的活动水平;6例患者自诉运动水平稍差,但不影响日常生活;3例患者在步行超过30 min以上时仍可出现踝关节疼痛及肿胀;1例自觉症状与术前无好转.结论 踝关节镜是诊断踝关节撞击征的良好手段,同时也是踝关节撞击征的一种微创治疗对策,可取得较高的满意率.     

关节镜下治疗踝关节软组织撞击综合征

目的 对踝关节软组织撞击综合征的关节镜下诊断和治疗进行初步探讨。方法 对近年来３０例踝关节软组织撞击综合征的关节镜下诊治经验进行总结。术前体检发现肿胀和疼痛以踝前外侧为主２４例,以踝前内侧为主６例在伤后半年～１年进行手术。关节镜下见到不同程度的滑膜增生、肥厚,韧带的撕裂或软骨损伤,均在关节镜下予以切除并清理关节。结果 术后平均随访２年４个月,优７例,良１９例,可４例,优良率８７％。结论 踝关节扭伤     

Arthroscopic treatment for impingement of the anterolateral soft tissues of the ankle

We treated 52 patients with impingement of the anterolateral soft tissues of the ankle by arthroscopic debridement. All had a history of single or multiple inversion injuries, without instability. One half had negative stress radiographs (stable group), while the others were positive (unstable group). Their mean age was 31 years and there were 35 men and 17 women. The results were assessed at a mean follow-up of 30 months. Three patients (6%) had a fair result, while 49 (94%) had an excellent or good outcome. No difference was found in the final results between the two groups (p > 0.05). We conclude that anterolateral impingement of the ankle should be considered in a patient with chronic anterolateral pain after an injury, regardless of the stability of the ankle.     

Arthroscopic treatment of anterior ankle impingement syndrome in dancers

BACKGROUND: The purpose of this study was to evaluate the results of arthroscopic treatment of anterior bony and soft-tissue impingement of the ankle in elite dancers. METHODS: The study is a case series retrospectively reviewed. In the period between 1990 and 1999, 11 elite dancers (12 ankles) had ankle arthroscopy after a diagnosis of anterior ankle impingement that markedly interfered with their dancing. Initial nonoperative treatment failed in all subjects. Previous ankle trauma was noted in all subjects. There were seven women and four men (average age 28 years). Tibiotalar exostoses were radiographically noted in six ankles. Standard anteromedial and anterolateral arthroscopic portals and instrumentation were used for resection of bone spurs and debridement of impinging soft tissues. Patients were nonweightbearing for 5 days after surgery and had postoperative physiotherapy. RESULTS: Nine dancers returned to full dance activity at an average of 7 weeks after surgery. One patient did not return to dance performance because of concurrent unrelated orthopaedic problems, but he resumed work as a dance teacher; he developed a recurrent anterior tibial spur that was successfully resected at a second arthroscopy 9 years later. Another dancer developed postoperative scar-tissue impingement and stiffness; she had a repeat arthroscopy 4 months after the initial procedure and subsequently returned to dance performance. All patients eventually had marked postoperative improvement in pain relief and dance performance. CONCLUSIONS: Arthroscopic debridement is an effective method for the treatment of bony and soft-tissue anterior ankle impingement syndrome in dancers and has minimal morbidity.     

Arthroscopic treatment of anterior ankle impingement

Anterior ankle impingement is a common cause of chronic ankle pain in the athletic population. Its cause can be either soft tissue or osseous in nature. Arthroscopic debridement results in favorable and reproducible outcomes. However, in the population in which ankle instability or narrowing of the ankle joint occur, outcomes may be less favorable.     

关节镜治疗踝关节不稳合并前内侧撞击综合征

目的:探讨关节镜治疗踝关节不稳合并前内侧撞击综合征的手术技巧及疗效.方法:回顾性分析2019年2月至2020年8月收治的13例踝关节不稳合并前内侧撞击综合征患者.男10例,女3例;年龄(40.0±15.1)岁;病程(44.1±33.2)个月.所有患者有明确扭伤史,MRI证实踝关节距腓前韧带损伤,踝关节背伸时存在前内侧疼...     

Distraction-free ankle arthroscopy for anterolateral impingement

The origin of chronic pain after external ankle sprain is better known with arthroscopy’s contribution. Chronic hypertrophic synovitis of the anterolateral ankle region is seemingly the cause, resulting in “anterolateral ankle impingement.” But is partial synovectomy with fibrosis resection under arthroscopy always possible without any distraction? Are results affected? This retrospective study concerned only patients with soft tissue ankle impingement. All cases with bone and joint diseases were excluded. The final sample of 24 patients had a mean age of 35 years (21–54 years) and presented anterolateral mechanical pain associated with oedema following external ankle sprain. Medical and rehabilitative treatment was undertaken for more than 6 months before arthroscopy. Average time between trauma and arthroscopy was 21 months (5–60 months). Clinical examination revealed no ankle instability or laxity. Debridement with joint lavage was systematically performed under arthroscopy without any distraction. Average patient follow-up was 22 months (12–92 months). All patients had a good Kitaoka score, with 22 patients registering excellent results. There were no septic complications or algodystrophy. Two transient hypoesthesias were observed in the dorsal surface and lateral border of the foot with full postoperative recovery at 6 months. Distraction was never used and simple dorsiflexion was sufficient to perform arthroscopic debridement. In this study, anterolateral ankle impingement diagnosis was primarily clinical. Arthroscopic treatment yielded significant benefits on pain, oedema and resumption of sport activities. Arthroscopic treatment of anterolateral ankle impingements is thus possible with simple dorsiflexion and no distraction, resulting in a possible decrease in complication rates. Level of evidence Retrospective cohort study, Level IV.     

Arthroscopic treatment of anterior impingement in the ankle

We performed a prospective study to assess the long-term outcome of 57 arthroscopic debridement procedures carried out to treat anterior impingement in the ankle. Using preoperative radiographs, we grouped patients according to the extent of their osteoarthritis (OA). The symptoms of those with grade-0 changes could be attributed to anterior soft-tissue impingement alone. Patients with grade-I disease had both anterior soft-tissue and osteophytic impingement, but no narrowing of the joint space. In those with grade-II OA, narrowing of the joint space was accompanied by osteophytic impingement. Radiographs taken before and after operation and at follow-up were compared to assess the recurrence of osteophytes and the progression of narrowing of the joint space. At a mean follow-up of 6.5 years (5 to 8) all patients without OA had excellent or good results. There were excellent or good results in 77% of patients with grade-I OA, despite partial or complete recurrence of osteophytes in two-thirds. In most patients with grade-II OA, narrowing of the joint space had not progressed at follow-up. There was a notable improvement in pain in these patients, 53% of whom had excellent or good results. Although some osteophytes recurred, at long-term follow-up arthroscopic excision of soft-tissue overgrowths and osteophytes proved to be an effective way of treating anterior impingement of the ankle in patients who had no narrowing of the joint space.