Mouhsine E, Crevoisier X, Leyvraz P F, Akiki A, Dutoit M, Garofalo R
Department of Orthopedic Surgery and Traumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2004 May;12(3):250-3. doi: 10.1007/s00167-003-0465-5. Epub 2004 Jan 28.
The purpose of this paper is to discuss the post-traumatic overload syndrome of the os trigonum as a possible cause of posterior ankle impingement and hindfoot pain. We have reviewed 19 athletes who were referred to our foot unit between 1995 and 2001 because of posterior ankle pain, and in whom a post-traumatic overload syndrome of os trigonum was diagnosed. All these patients were followed up over a period of 2 years. In 11 cases a chronic repetitive movements in forced plantar flexion was found. In the other eight cases the pain appeared to persist after a standard treatment of an ankle sprain in inversion plantar flexion. The diagnosis was based on clinical history, physical examination and X-rays that revealed a non-fused os trigonum. The confirmation of diagnosis was carried-out injecting local anaesthetic under fluoroscopic control. In all cases a corticosteroid injection as first line treatment was performed. In 6 cases a second injection was necessary to alleviate pain because incomplete recovery with the first injection. Three cases (16%) were recalcitrant to this treatment and in these three cases a surgical excision of the os trigonum was carried out. Our conclusion is that after some chronic athletic activity or an acute ankle sprain the os trigonum, if present, may undergo mechanical overload, remain undisrupted and become painful. Treatment by corticosteroid injection often resolves the problem.
本文旨在探讨三角骨创伤后过载综合征作为后踝撞击和后足疼痛可能原因的情况。我们回顾了1995年至2001年间因后踝疼痛转诊至我们足部科室的19名运动员，他们均被诊断为三角骨创伤后过载综合征。所有这些患者均接受了为期2年的随访。其中11例发现存在强迫跖屈时的慢性重复性动作。另外8例患者在跖屈内翻位踝关节扭伤的标准治疗后疼痛仍持续。诊断基于临床病史、体格检查以及X线检查显示三角骨未融合。通过在透视控制下注射局部麻醉剂来确诊。所有病例均首先进行了皮质类固醇注射治疗。6例患者因首次注射后恢复不完全而需要第二次注射以缓解疼痛。3例（16%）患者对该治疗无效，这3例患者接受了三角骨手术切除。我们的结论是，在经历一些慢性体育活动或急性踝关节扭伤后，如果存在三角骨，可能会承受机械过载，保持完整但变得疼痛。皮质类固醇注射治疗通常可解决该问题。
