踝关节软组织撞击综合征临床研究

目的:总结与探讨踝关节软组织撞击综合征发生的相关因素、关节镜下表现和组织病理学特点。方法:自2000年11月至2005年4月,本所共收治21例踝关节撞击综合征患者,其中男性16例,女性5例,平均年龄24·7岁。运动员7例,非运动员14例。左踝9例,右踝12例。对所有患者均进行关节镜探查,镜下切除造成撞击的组织,同时对其进行病理检查。结果:21例患者中有20例发生于踝关节扭伤后,其中16例为内翻伤。单纯前外侧撞击9例,单纯前内侧撞击2例,单纯外侧撞击1例,前内和前外撞击同时存在9例。关节镜下发现撞击组织为滑膜组织的20例,下胫腓前韧带远侧束5例,纤维瘢痕组织4例,距腓前韧带组织3例,半月板样组织3例。合并关节软骨损伤16例。病理检查确认造成撞击的组织为慢性炎症性滑膜组织、韧带组织、肉芽组织。半月板样组织病理表现为慢性滑膜炎或致密结缔组织伴软骨化生,或慢性滑膜炎伴肉芽组织形成。结论:踝关节软组织撞击综合征多发生在创伤后,尤其内翻伤后较常见。部位以踝关节前外侧多见,内侧也可发生。撞击组织以滑膜组织最常见,其次为下胫腓前韧带远侧束增厚、纤维瘢痕组织和损伤的距腓前韧带组织。软组织撞击部位与软骨损伤部位符合程度不显著(χ~2=2·524,P=0·112)。

Clinical Observation of Ankle Impingement Syndrome

Objective To introduce the treatment of ankle impingement syndrome through arthroscopy and to study pathological characteristics and relative factors of impingement syndrome. Materials and Methods Twenty one patients with ankle impingement syndrome were treated in the Third Hospital of Peking University. There were 16 males and 5 females. 7 patients were athletes and 11 were non-athletes. Average age of the patients was 24.7 yrs. Left ankles were involved in 9 and right in 12. All patients were treated with arthroscopic removal of the impingement soft tissues, and the samples were sent for pathological study. Results Twenty patients had history of ankle sprain. 9 had anterolateral impingement and two had anteromedial impingement. There was lateral and anterolateral impingement in 1 patient and medial and anterolateral impingement in 9. In our study, impingement soft tissues were found to be synovium, distal fascicle of anterior tibiofibular ligament, fibrous scar, anterior talofibular ligament and meniscoid tissue. Impingement syndrome was combined with cartilage injury in 16 patients. Pathological study confirm that these soft tissues including meniscoid tissue were derived from synovium or compact connective tissue with chondrometaplasia or synovium combined with granulation tissue. Conclusions Ankle impingement syndrome often occurs following ankle sprain, mostly caused by inversion trauma. Impingement soft tissues were synovium, distal fascicle of anterior tibiofibular ligament, fibrous scar, anterior talofibular ligament or meniscoid tissue in which synovium is most common. The relationship between impingement and cartilage injury is not significant (P=0.112). Further study should be done when more cases are included.