CAJ | 학술논문

目的探讨跗骨窦综合征的关节镜下手术治疗效果.方法 2006年7月-2008年5月,共治疗跗骨窦综合征患者15例,男6例,女9例;年龄26～63岁,平均46.3岁.均为单侧患者,左侧10足,右侧5足.所有患者均在侧卧位、止血带下手术.术中采用外侧、前外侧和后外侧入路,必要时增加内侧入路.随访采用视觉模拟疼痛评分(VAS)和美国足踝外科协会(America Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分.结果所有患者在关节镜下均有2个以上阳性表现,包括跗骨窦内瘢痕组织增生、炎症,距下关节内软组织撞击,距下关节滑膜炎,距下关节囊部分损伤,距跟骨间韧带部分损伤,颈韧带部分损伤,软骨面损伤,距下关节退行性变.所有患者均获得19～35个月(平均26.1个月)随访,VAS评分由术前7.6分(6～9分)减少到末次随访时的2.5分(1～4分)(P＜0.01),AOFAS评分由术前41.9分(20～67分)提高到末次随访时的83.1分(70～100分)(P＜0.01).末次随访时AOFAS踝-后足功能评分优良率达到73%.结论对保守治疗无效的跗骨窦综合征患者应积极进行关节镜下手术治疗,能够获得较好的临床效果.
목적 탐토부골두종합정적관절경하수술치료효과.방법 2006년7월-2008년5월,공치료부골두종합정환자15례,남6례,녀9례;년령26～63세,평균46.3세.균위단측환자,좌측10족,우측5족.소유환자균재측와위、지혈대하수술.술중채용외측、전외측화후외측입로,필요시증가내측입로.수방채용시각모의동통평분(VAS)화미국족과외과협회(America Orthopedic Foot and Ankle Society,AOFAS)과-후족공능평분.결과 소유환자재관절경하균유2개이상양성표현,포괄부골두내반흔조직증생、염증,거하관절내연조직당격,거하관절활막염,거하관절낭부분손상,거근골간인대부분손상,경인대부분손상,연골면손상,거하관절퇴행성변.소유환자균획득19～35개월(평균26.1개월)수방,VAS평분유술전7.6분(6～9분)감소도말차수방시적2.5분(1～4분)(P＜0.01),AOFAS평분유술전41.9분(20～67분)제고도말차수방시적83.1분(70～100분)(P＜0.01).말차수방시AOFAS과-후족공능평분우량솔체도73%.결론 대보수치료무효적부골두종합정환자응적겁진행관절경하수술치료,능구획득교호적림상효과.
Objective To investigate the result of arthroscopic surgery in the treatment of sinus tarsi syndrome. Methods The study involved 15 patients (6 males and 9 females) with sinus tarsi syndrome admitted to First Hospital of Nanjing from July 2006 to May 2008. The age of the patients ranged from 23 to 63 years ( average 46.3 years). All the patients had one side involvement, including 10 patients with left side involvement and five with right side involvement. All the operations were performed under the tourniquet control and the patients were placed at the lateral decubitus position. The lateral, anterolateral and posterolateral portals were applied intraoperatively and the medial portal was applied when necessary. Visual analogue scale (VAS) and American orthopedic foot and ankle scale (AOFAS) ankle-hindfoot scale were used for follow-up evaluation. Results More than two lesions were found under arthroscope in all patients. The lesions included scar tissue hypertrophy and inflammation in the sinus tarsal canal, soft tissue impingement in the subtalar joint, synovitis, partial tears of subtalar capsule, interosseous talocalcaneal ligament or cervical ligament, cartilage injury and subtalar degeneration. All patients were followed up for 19-35 months (mean 26. 1 months). At the final follow-up, the VAS score was improved from preoperative 7.6 points ( range 6-9 points) to postoperative 2.5 points (range 1-4 points) (P＜0.01 ), and the AOFAS score improved from preoperative 41. 9 points (range 20-67 points) to postoperative 83. 1 points ( range 70-100 points) ( P ＜ 0. 01 ). The excellence rate of the AOFAS score reached 73% at the final follow-up. Conclusion For patients with sinus tarsi syndrome after a failed conservative treatment, arthroscopic surgery should be performed as soon as possible and the clinical result is satisfactory.