创伤后踝关节慢性疼痛的关节镜诊治

目的：探讨对创伤后慢性踝关节疼痛患者行关节镜检查的诊断和治疗价值。方法：自1999年4月至2008年6月,收治39例创伤后踝关节慢性疼痛的患者,男15例,女24例;年龄15～58岁,平均32岁。病程2个月～11年,平均18个月,其中X线显示受伤时骨折脱位者26例。均行关节镜检查,明确关节内病变状况,并对相应病变行镜下清理术,采用美国足踝外科学会（AOFAS）后足踝评分表对手术前后功能状况进行评分。结果：软骨损伤及退变26例,游离体形成3例,撞击综合征21例。引起主要撞击的组织有：滑膜增生3例;韧带断裂后断端撞击10例,包括距腓前韧带断裂7例,下胫腓韧带前内侧束远端断裂3例;半月板样组织撞击6例;骨软骨增生撞击3例。平均随访（14.2±8.4）个月（5～36个月）,术后关节功能AOFAS评分由术前的平均（59.7±16.9）分改善为（68.8±21.2）分,其中主观评分改善更为明显,术前平均（22.8±10.0）分,术后（29.5±12.1）分。结论：对于踝关节损伤后慢性疼痛患者,尤其是X线无骨折脱位者,及时行关节镜检查,有助于明确关节内具体病变状况,且术中一并进行关节清理,能显著改善关节功能。

Arthroscopic diagnosis and treatment of posttraumatic chronic ankle pain

Objective: To evaluate the arthroscopic diagnosis and treatment of the chronic ankle pain after injury. Methods: From April 1999 to June 2008,39 patients with posttraumatic chronic ankle pain were treated. The mean duration between the initial injury and treatment was 18 months(2 months to 11 years). There were 15 males and 24 females with a mean age of 32 years (15 to 58 years). All the patients were treated with arthroscopic debridement. The preoperative and postoperative ankle functions were evaluated by the AOFAS (the American Orthopaedic Foot and Ankle Society) Clinical Rating System for the ankle-hindfoot. Results: Twenty-six patients had osteochondral lesions. Impingement syndrome in ankle was observed in 21 patients. The impingement tissue included synovial hypertrophy in 3 patients,ligament injury in10 patients (7 patients had anterior talofibular ligament injury and 3 patients had anteroinferior tibiofibular ligament injury),meniscoid tissue in 6 patients,pathological labrum in 3 patients. All the patients were followed up with an average of(14.2±8.4) months(ranged from 5 to 36 months). The AOFAS scores increased significantly from pre-operative (59.7±16.9) to post-operative (68.8±21.2),and it was obvious in relieving pain,which was pre-operative (22.8±10.0) and post-operative (29.5±12.1). Conclusion: Arthroscopy can be used to diagnose the cause of chronic ankle pain after injury. Furthermore,arthroscopic debridement was useful to relieve the pain and improve the joint function,and it is appropriate for patients who had no fractures and dislocations.