创伤性踝关节病变关节镜诊治.docVIP

创伤性踝关节病变关节镜诊治 　 作者：洪剑飞 夏冰毕擎 邱斌松 陈灿平 黄公怡 【摘要】 目的 对创伤性踝关节疼痛关节镜下的诊断和治疗进行初步探讨。 方法 43例病程半年以上创伤性踝关节疼痛患者行关节镜检查，并进行治疗。 结果 镜检下与关节疼痛有关病理类型：(1)关节不稳定征（外侧和下胫腓联合韧带损伤）；(2)撞击征（前踝骨赘和前外侧软组织损伤）；(3)软骨和骨软骨骨折；(4)非特异性骨关节炎和（或）滑膜炎。作镜下关节内清理、关节软骨面修整、骨赘切除、纤维束带切除等，术后关节腔内注射透明质酸钠和关节功能锻炼。术后随访25例，优10例，良13例，可2例，优良率92.0％。 结论 踝关节镜对诊断和治疗创伤性踝关节疼痛有重要价值。 【关键词】 创伤性踝关节疼痛 踝关节镜 诊断和治疗 　　【Abstract】 Objective To explore the application of arthroscopic surgery for diagnosing and treating the traumatic ankle pain. Methods 43 patients of traumatic ankle pain with a history of above 0.5 years were treated with arthroscopic surgery. The pathology changes of this group were classified into four types:①Instabilities (lateral and syndesmotic injury)②Impingements(anterior osteophytes and anterolateral soft-tissue injury)③Articular lesions(chondral and osteochondral fracture)④Nonspecific osteoarthritis with or without synovitis.The arthroscopic surgery included in debridement, repairing articular cartilage cutting the osteophyte and resaction of fiberal band. The joint cavity was injected with HA and early exercise of joint were encouraged postoperatively .Results 25 cases were followed up more than six months.10 of them were excellent in recovery ,13 patients were good and 2 cases were fair. The satisfactory rate was 92%(23cases). Conclusions Arthroscopic surgery has clinical value in the diagnosis and treatment of traumatic ankle pain. 　　【Key words】 Traumatic ankle pain Arthroscopic surgery Diagnosis and treatment 　　创伤性踝关节病变约占骨科门诊的3％～4％，是严重影响人们日常生活和工作的疾患之一。传统的治疗方法，如口服消炎止痛药物、关节内封闭及做踝关节融合手术等，疗效均不理想。本院自2000年6月以来，在踝关节镜监视下采用美国Arthro Care System2000型射频汽化仪汽化和用关节镜刨削器刨削等方法，对43例病程在半年以上的创伤性踝关节疼痛患者行关节镜下手术治疗，并配以关节腔内注射透明质酸钠和关节功能锻炼，取得了较满意的疗效。现报告如下。 　　1 临床资料 　　1.1 一般资料 　　本组43例，其中男23例，女20例，年龄19～68岁(平均42.5岁)；左踝22例、右踝21例，均为单侧；病程6个月～6年(平均4.3年)。早期踝关节损伤按Lauge-Hansen分型：A型15例，B型16例，C型6例，D型6例。其中D型6例曾行螺钉内固定手术(术后2个月去除内固定)，其余病例伤后早期均采用手法复位石膏外固定治疗(6周后拆除外固定)；X线片示关节边缘有轻度反应性增生性变化15例，有严重反应性增生性变化伴骨赘形成5例；经半年以上的保守治疗，症状均未明显缓解。术前43例按Baird等［１］踝关节评分，均为差。