慢性踝关节不稳合并后踝撞击同期手术中长期疗效及影响因素分析

doi:10.19723/j.issn.1671-167X.2019.03.019

北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (3): 505-509. doi: 10.19723/j.issn.1671-167X.2019.03.019

慢性踝关节不稳合并后踝撞击同期手术中长期疗效及影响因素分析

江东,胡跃林^△(),焦晨^△(),郭秦炜,谢兴,陈临新,赵峰,皮彦斌

北京大学第三医院运动医学研究所,北京 100191

收稿日期:2019-03-22 出版日期:2019-05-22 发布日期:2019-06-26
作者简介:胡跃林,北京大学第三医院运动医学研究所主任医师,硕士生导师。担任中国医师协会骨科医师分会足踝外科工作委员会运动医学与关节镜学组顾问委员、国际矫形与创伤外科学会中国部足踝专业委员会常务委员、中国研究型医院学会足踝医学专业委员会副主任委员、中国足球协会医学委员会副主任委员、中国医疗保健国际交流促进会运动损伤防治分会副主任委员、中国医师协会科学普及分会运动康复专业委员会主任委员、中国医师协会医学科学普及分会常务委员、北京医学会骨科学分会足踝外科学组组长、海淀区医疗事故鉴定委员会专家库成员。获教育部科技进步二等奖2项,国家体育总局科学技术进步奖二等奖2项、三等奖2项,北京市科学技术奖二等奖1项。作为特聘专家,主持或参与2008年北京奥运会和残奥会、1990年北京亚运会、2013年亚洲联赛冠军杯决赛、全国体操锦标赛、北京国际马拉松赛等赛事的医疗保障工作。发表论文40余篇,主编及参编著作7部。主要研究方向为运动创伤及运动康复,针对慢性踝关节不稳、距骨骨软骨损伤、跟腱损伤等开展了系统的基础和临床研究。|焦晨,北京大学第三医院运动医学研究所足踝外科主任,主任医师、医学博士。担任北京大学骨科学系足踝外科学组副组长、中国奥运会国家队医疗专家、中华医学会骨科学分会足踝外科学组青年委员会副主任委员、中国研究型医院学会足踝医学专业委员会委员、北京市中西医结合学会足踝医学专业委员会常务委员、北京医学会骨科学分会足踝外科学组委员、《中华临床医师杂志(电子版)》专业委员会委员、World Journal of Orthopaedics编委。获得省部级科学技术奖5项,发表SCI和国内统计源核心期刊论文20余篇,参编学术专著10余部。主要研究方向为运动创伤,尤其是足踝和膝关节运动创伤,包括踝关节韧带损伤、距下关节损伤、软骨损伤、足部运动损伤等。
基金资助:
北京大学临床医学+X青年专项(PKU2018LCXQ009)-中央高校基本科研业务费和北京大学第三医院院内重点项目(Y72484-2)

Mid-to-long term outcomes and influence factors of postoperative concurrent chronic ankle instability and posterior ankle impingement

Dong JIANG,Yue-lin HU^△(),Chen JIAO^△(),Qin-wei GUO,Xing XIE,Lin-xin CHEN,Feng ZHAO,Yan-bin PI

Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China

Received:2019-03-22 Online:2019-05-22 Published:2019-06-26
Supported by:
Supported by the Fundamental Research Funds for the Central Universities: Peking University Clinical Medicine Plus X-Young Scholars Project (PKU2018LCXQ009) and Clinical Key Project of Peking University Third Hospital (Y72484-2)

摘要/Abstract

摘要： 目的对慢性踝关节不稳合并后踝撞击综合征患者术后进行3~9年的随访,探讨其中长期疗效,并对其影响因素进行分析。方法 2010年2月—2015年12月于北京大学第三医院运动医学研究所接受外踝韧带修复和后踝关节镜清理同期手术的患者共47例,随访42例,其中男性26例、女性16例,平均年龄(28.9±10.0)岁。通过问卷及查体记录患者的临床症状、关节稳定性、活动度及运动机能等,对比术前和术后疼痛视觉模拟评分(visual analogue scale,VAS)、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)后足评分、运动机能Tegner评分,并分析临床评分与患者年龄、性别、身高、体重指数、受伤时间、手术用时、软骨损伤等因素的相关性。结果平均随访时间为(71.8±22.8)个月。患者术后VAS评分、AOFAS评分及Tegner评分均优于术前水平(1.0 vs. 5.0, 92 vs. 80, 6.5 vs. 2.0, P均<0.001),疗效优良率为97.6%,术后VAS评分(t=2.719,P=0.10)、AOFAS评分(t=-2.853,P=0.10)、Tegner评分(t=-3.443,P=0.001)和恢复运动时间(t=2.814,P=0.008)均与患者年龄呈负相关,术后VAS评分与软骨损伤呈负相关(Z=-2.195,P=0.028)。结论慢性踝关节不稳合并后踝撞击同期手术后的中长期临床效果良好,患者年龄与临床疗效呈负相关,合并软骨损伤可加重患者术后疼痛。

关键词: 踝关节, 关节不稳定性, 韧带损伤, 后踝撞击综合征, 关节镜

Abstract: Objective: To investigate the mid-to-long-term efficacy of patients with chronic ankle instability combined with posterior impingement syndrome after 3-9 years of follow-up, and to analyze the influencing factors.Methods: From February 2010 to December 2015, 46 patients underwent concurrent lateral ankle ligament repair with posterior ankle arthroscopic surgery at the Institute of Sports Medicine, Peking University Third Hospital. The patient was first placed in a prone position and underwent arthroscopic debridement for the posterior impingement. After finishing the posterior arthroscopy, the surgeon and assistants first translated the patient to the affected side, then turned to the healthy side, and changed the position to the supine position. During the turning over, another assistant held the arthroscope and the instrument to ensure that it was sterile and could be used without replacement. The anterior ankle arthroscopy was operated if necessary and the lateral ankle ligament repair was anatomic repaired with anchors. The 42 patients were followed up, including 26 males and 16 females. The average age was (28.9±10.0) years. The patient’s clinical symptoms, joint stability, mobility and motor function were compared by questionnaire and physical examination. The preoperative and postoperative visual analogue scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Tegner scores were compared, and the clinical scores and the patient age, gender, height and weight were compared. The correlations between body mass index (BMI), preoperative duration, surgery duration, and cartilage injury were analyzed. Results: The mean follow-up time was (71.8±22.8) months. The postoperative VAS scores (1.0 vs. 5.0, P<0.001), AOFAS scores (92 vs. 80, P<0.001), and Tegner scores (6.5 vs. 2, P<0.001) were significantly superior to the preoperative levels. The excellent and good rate was 97.6%. The postoperative VAS score (t=2.719, P=0.10), AOFAS score (t=-2.853, P=0.10), Tegner score (t=-3.443, P=0.001) and time to return exercise (t=2.814, P=0.008) were negatively correlated with the patient age, and the postoperative VAS score was negatively correlated with cartilage injury (Z=-2.195, P=0.028).Conclusion: The mid-to-long-term clinical outcomes of the chronic ankle ligament instability combined with the posterior impingement were good. The age of the patients was negatively correlated with the clinical outcome. The combined cartilage injury could aggravate the postoperative pain.

Key words: Ankle joint, Joint instability, Ligament injury, Posterior ankle impingement syndrome, Arthroscopy

中图分类号:

R684.77

江东,胡跃林,焦晨,郭秦炜,谢兴,陈临新,赵峰,皮彦斌. 慢性踝关节不稳合并后踝撞击同期手术中长期疗效及影响因素分析[J]. 北京大学学报（医学版）, 2019, 51(3): 505-509.

Dong JIANG,Yue-lin HU,Chen JIAO,Qin-wei GUO,Xing XIE,Lin-xin CHEN,Feng ZHAO,Yan-bin PI. Mid-to-long term outcomes and influence factors of postoperative concurrent chronic ankle instability and posterior ankle impingement[J]. Journal of Peking University(Health Sciences), 2019, 51(3): 505-509.

图/表 2

表1

表2

参考文献 16

[1]	Pereira H, Vuurberg G, Spennacchio P , et al. Surgical treatment paradigms of ankle lateral instability, osteochondral defects and impingement[J]. Adv Exp Med Biol, 2018,1059:85-108. doi: 10.1007/978-3-319-76735-2
[2]	Martins N, Seixas MI, Couto M , et al. Posterior ankle impingement syndrome[J]. Reumatol Clin, 2018,14(4):244-245. doi: 10.1016/j.reuma.2017.07.008
[3]	Hamilton W . Posterior ankle pain in dancers[J]. Clin Sports Med, 2008,27(2):263-277. doi: 10.1016/j.csm.2007.12.002
[4]	Scholten PE , Sierevelt IN, van Dijk CN. Hindfoot endoscopy for posterior ankle Impingement[J]. J Bone Joint Surg Am, 2008,90(12):2665-2672. doi: 10.2106/JBJS.F.00188
[5]	Roche AJ, Calder JD, Lloyd Williams R . Posterior ankle impingement in dancers and athletes[J]. Foot Ankle Clin, 2013,18(2):301-318. doi: 10.1016/j.fcl.2013.02.008
[6]	van Dijk CN, de Leeuw PA, Scholten PE . Hindfoot endoscopy for posterior ankle impingement: surgical technique[J]. J Bone Joint Surg Am, 2009,91(Suppl 2):287-298. doi: 10.2106/JBJS.I.00445
[7]	D’Hooghe P, Alkhelaifi K, Almusa E , et al. Chronic lateral ankle instability increases the likelihood for surgery in athletes with os trigonum syndrome [J/OL]. Knee Surg Sports Traumatol Arthrosc, ( 2018-10-01) [2019-02-18]. https://doi.org/10.1007/s00167-018-5183-0 .
[8]	孙世伟, 庄泽, 徐如彬 , 等. 踝关节镜前后联合入路治疗踝关节撞击综合征[J]. 中国骨伤, 2016,29(12):1078-1083.
[9]	赵志宏, 王雪松, 刘心 , 等. 非牵引漂浮体位前后踝联合关节镜技术治疗前后踝撞击症[J]. 中国运动医学杂志, 2013,32(12):1047-1051.
[10]	Allegra F, Bonacci E, El Boustany S , et al. Endoscopy of the posterior aspect of the ankle: double posteromedial portals[J]. Sports Med Arthrosc, 2016,24(1):24-28. doi: 10.1097/JSA.0000000000000098
[11]	Song B, Li C, Chen Z , et al. Combined anterior and dual posterolateral approaches for ankle arthroscopy for posterior and anterior ankle impingement syndrome[J]. Foot Ankle Int, 2016,37(6):605-610. doi: 10.1177/1071100716632042
[12]	Miyamoto W, Miki S, Kawano H , et al. Surgical outcome of posterior ankle impingement syndrome with concomitant ankle disorders treated simultaneously in patient engaged in athletic activity[J]. J Orthop Sci, 2017,22(3):463-467. doi: 10.1016/j.jos.2016.12.017
[13]	Miyamoto W, Takao M, Matsui K , et al. Simultaneous ankle arthroscopy and hindfoot endoscopy for combined anterior and posterior ankle impingement syndrome in professional athletes[J]. J Orthop Sci, 2015,20(4):642-648. doi: 10.1007/s00776-015-0712-x
[14]	Jiang D, Ao YF, Jiao C , et al. Concurrent arthroscopic osteochondral lesion treatment and lateral ankle ligament repair has no substantial effect on the outcome of chronic lateral ankle instability[J]. Knee Surg Sports Traumatol Arthrosc, 2018,26(10):3129-3134. doi: 10.1007/s00167-017-4774-5
[15]	Georgiannos D, Bisbinas I . Endoscopic versus open excision of os trigonum for the treatment of posterior ankle impingement syndrome in an athletic population: A randomized controlled study with 5-year follow-up[J]. Am J Sports Med, 2017,45(6):1388-1394. doi: 10.1177/0363546516682498
[16]	Guo QW, Hu YL, Jiao C , et al. Open versus endoscopic excision of a symptomatic os trigonum: a comparative study of 41 cases[J]. Arthroscopy, 2010,26(3):384-390. doi: 10.1016/j.arthro.2009.08.029

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Items	VAS score	AOFAS score	Tegner score
Preoperative	5.0 (0-9)	80 (60-100)	2 (1-8)
Follow-up	1.0 (0-3)	92 (50-100)	6.5 (1-10)
Z	-5.643	-5.114	-5.121
P	<0.001	<0.001	<0.001

Items	VAS score		AOFAS score		Tegner score		Return sports time
Items	Statistical value	P	Statistical value	P	Statistical value	P	Statistical value	P
Age	2.719	0.010	-2.853	0.007	-3.443	0.001	2.814	0.008
Gender	-1.893	0.058	-1.420	0.156	-0.509	0.611	-0.827	0.408
BMI	0.898	0.375	1.267	0.213	-0.053	0.958	-0.519	0.607
Preoperative duaration	-1.105	0.276	-0.076	0.940	0.295	0.769	1.580	0.122
Surgery duration	-0.530	0.600	-1.148	0.258	-0.296	0.769	1.540	0.131
Cartilage injury	-2.195	0.028	-1.154	0.249	-1.928	0.054	-0.322	0.747

慢性踝关节不稳合并后踝撞击同期手术中长期疗效及影响因素分析

Mid-to-long term outcomes and influence factors of postoperative concurrent chronic ankle instability and posterior ankle impingement

RICH HTML

PDF (PC)

摘要/Abstract

引用本文

使用本文

图/表 2

参考文献 16

相关文章 15

Metrics

本文评价

推荐阅读 10

[1]	邵振兴,宋庆法,赵宇晴,崔国庆. 一种结合线袢固定的关节镜下“嵌入式”喙突移位术:手术技术及术后影像学分析[J]. 北京大学学报（医学版）, 2021, 53(5): 896-901.
[2]	蒋艳芳,王健,王永健,刘佳,裴殷,刘晓鹏,敖英芳,马勇. 前交叉韧带翻修重建术后中长期临床疗效及影响因素[J]. 北京大学学报（医学版）, 2021, 53(5): 857-863.
[3]	郑佳鹏,肖棋,邓辉云,吴清泉,翟文亮,林达生. 外侧半月板腘肌腱区损伤的关节镜下分型和处理[J]. 北京大学学报（医学版）, 2021, 53(5): 891-895.
[4]	董寒梅,吴睿麒,高冠英,刘镕阁,徐雁. 关节镜下盂唇重建治疗髋关节撞击综合征12例[J]. 北京大学学报（医学版）, 2021, 53(5): 1007-1011.
[5]	侯宗辰,敖英芳,胡跃林,焦晨,郭秦炜,黄红拾,任爽,张思,谢兴,陈临新,赵峰,皮彦斌,李楠,江东. 慢性踝关节不稳患者足底压力特征及相关因素分析[J]. 北京大学学报（医学版）, 2021, 53(2): 279-285.
[6]	刘中砥,许庭珉,党育,张殿英,付中国. 关节镜下改良outside-in穿刺缝合技术修复半月板撕裂的中期临床随访[J]. 北京大学学报（医学版）, 2020, 52(5): 870-874.
[7]	张翠平,刘佩佩,傅强,高冠英,崔立刚,徐雁,王健全. 超声引导下髋关节药物注射在关节镜盂唇修复术后康复中的应用[J]. 北京大学学报（医学版）, 2019, 51(2): 265-267.
[8]	王荣丽，周志浩，席宇诚，王启宁，王宁华，黄真. 机器人辅助脑瘫儿童踝关节康复临床初步研究[J]. 北京大学学报(医学版), 2018, 50(2): 207-212.
[9]	刘晓东，崔立刚，徐雁，孙洋，郝云霞，宋琳. 超声在髋关节前上盂唇撕裂中的应用[J]. 北京大学学报(医学版), 2017, 49(6): 1014-1018.
[10]	荣艳波，田光磊，陈山林. 深层桡尺远侧韧带对桡尺远侧关节稳定作用的生物力学研究[J]. 北京大学学报(医学版), 2017, 49(3): 518-521.
[11]	姬洪全，周方，田耘，张志山，郭琰，吕扬，杨钟玮，侯国进. 手术治疗Maisonneuve骨折失误1例报告[J]. 北京大学学报(医学版), 2017, 49(2): 354-356.
[12]	龚晓峰，吕艳伟，王金辉，王岩，武勇，王满宜. 踝关节CT与踝关节骨折分型的相关性研究[J]. 北京大学学报(医学版), 2017, 49(2): 281-285.
[13]	王子昀，吴新宝. 手术复位不良导致的腓骨前脱位1例[J]. 北京大学学报(医学版), 2016, 48(2): 361-365.
[14]	张辉，刘心，洪雷，耿向苏，冯华. 全关节镜下腘肌腱重建与切开腘腓韧带重建治疗膝关节后外旋转不稳定的对比[J]. 北京大学学报(医学版), 2016, 48(2): 237-243.
[15]	刘波，陈山林，朱瑾，王志新，杨辰，沈杰，田光磊. 腕关节镜辅助微创治疗月骨周围脱位[J]. 北京大学学报(医学版), 2016, 48(2): 234-236.