关节镜治疗痛性腓下骨的临床疗效

目的 :探讨踝关节镜对症状性腓下骨的治疗作用。方法 :回顾性研究自2005年12月至2014年8月踝关节镜治疗腓下骨相关的外踝疼痛16例,平均年龄(33.5±15.6)岁,男11例,女5例。腓下骨平均最大直径(0.70±0.26)cm。关节镜下切除腓下骨,如存在距腓前韧带损伤则同时修复损伤的韧带。术后平均随访(18.0±4.5)个月,使用美国足踝外科协会(AOFAS)踝-后足疼痛与功能评分、Tegner运动水平分级和视觉模拟评价(visual analogue scale,VAS)评价术前及末次随访时足踝关节功能。结果:术前及末次随访时AOFAS评分分别为60.15±14.52及92.35±5.73,末次随访时评分高于术前(t=-8.251,P=0.000);VAS评分术前及末次随访时分别为7.35±0.46及2.45±0.98,末次随访时评分低于术前(t=18.105,P=0.000);Tegner运动等级评分术前及末次随访时分别为2.87±1.12及5.78±1.06,末次随访时评分高于术前(t=-7.548,P=0.000)。结论:腓下骨相关性外踝疼痛病例,除外腓下骨的大小,关节镜下腓下骨切除可以获得满意的临床疗效。

Clinical outcome of arthroscopic excision of the os subfibulare in ankle pain

Objective:To evaluate the clinical effect of arthroscopic excision of the os subfibulare in anterior-lateral ankle pain. Methods:From December 2005 to Augest 2014,16 patients suffering from pain associated with an os subfibulare in the anterior-lateral side of their ankles were reviewed. Among the patients,11 patients were male and 5 were female,with a mean age of (33.5±15.6) years old. The mean maximum diameter of os subfibulare was(0.70±0.26) cm. All the patients underwent excision of the osseous fragments,and had anatomic reconstruction of the anterior talofibular ligament if the anterior-lateral ankle was instable. The average follow-up period was(18.0± 4.5) months. To analyze the surgical outcome,American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot pain and function scales,visual analogue scale(VAS),and Tegner activity scale were assessed preoperatively and postoperatively. Results:AOFAS scales were preoperative 60.15±14.52 and postoperative 92.35±5.73. There was a significant difference between them(t=-8.251,P=0.000). The mean VAS score were preoperative 7.35±0.46 and postoperative 2.45±0.98. Statistical significance was also notable(t=18.105,P=0.000). Tegner score was significantly increased from preoperative 2.87±1.12 to postoperative 5.78±1.06(t=-7.548,P=0.000). Conclusion:Irrespective of the size of os subfibulare,in patients with pain or instability associated with the os subfibulare,arthroscopic excision combined with reconstruction of the anterior talofibular ligament or not was effective in restoring ankle function and eliminating pain.