关节镜清理术治疗前踝撞击征的疗效

目的:探讨踝关节镜对前踝撞击征的诊疗价值。方法:采用关节镜清理术治疗前踝撞击综合征33例,其中男23例,女10例。年龄平均39岁(18～72岁)。左踝16例,右踝17例。病史6个月至20年,有运动损伤史13例,踝关节扭伤病史17例,踝关节骨折史3例。临床表现为踝关节肿胀、疼痛和下蹲活动受限。X线片显示胫骨前唇和距骨骨质增生,MRI显示距骨软骨损伤,踝关节腔内积液。采用局麻关节镜下骨赘磨削,滑膜切除,踝关节清理术。结果:随访33例,平均时间35个月(4个月-6年)。术后踝关节背伸活动功能正常,按照McGuire踝关节评分系统对术前、术后踝关节功能进行评估,术前平均55分,术后平均80分,术后提高了25分。优13例,良15例,可3例,差2例,优良率84.8%。结论:局麻下踝关节镜骨赘切除、滑膜刨削和软骨修整可有效解除踝关节撞击症状,手术创伤小、功能恢复快,效果满意。

Therapeutic Effect of Arthroscopic Debridement for Anterior Ankle Impingement

Objective:To explore therapeutic value of arthroscopy for anterior ankle impingement.Method:Thirty-three patients were treated with arthroscopy because of anterior ankle impingement, including 23 males and 10 females, left for 16 cases and right for 17 cases, with the mean age of 39 years(range 18-27 years).13 patients had exercise hurt experience, 17 patients repeatedly had sprained ankle joints, 3 patients had the history of ankle fracture.All ankles of patients were pain and swelling.Squatting movement of ankle joint was limited.X-ray revealed osteophyma of anterior lip of tibia and talus.MRI showed the lesion of talus' cartilage.The arthro-scopic operation included under local anesthesia removalling of hyperplastic and pachyntic or inflame synovium, cataplasia cartilage and osteophyma.Results:33 patients were followed up for 4 months-6 years(mean month of 35 months).According to McGuire score system, the preoperative score was 55 points and postoperative score was 80 points.In all postoperative patients, 13 cases had excellent results, 15 good, 3 fair and 2 poor.Satisfactory rate was 84.8%.There was significant improvement in the range of dorsiflexion.Conclusion:The arthroscopic operation under local anesthesia can efficiently remove impingement complaint of ankle joint and has the advantages of minimal invasion, quick recovery and less complication.Therapeutic effect of arthroscopy debridement for anterior ankle impingement is satisfactory.