van Dijk C Niek
Department of Orthopedic Surgery, AMC Hospital/University of Amsterdam, Amsterdam, The Netherlands.
Instr Course Lect. 2006;55:545-54.
Hindfoot pain can be caused by a variety of pathologies, most of which can be diagnosed and treated with endoscopy. The main indications are posterior tibial tenosynovectomy, diagnosis of a longitudinal peroneus brevis rupture, peroneal tendon adhesiolysis, flexor hallucis longus release, os trigonum removal, endoscopic treatment of retrocalcaneal bursitis, endoscopic treatment of Achilles (peri)tendinopathy, and treatment of ankle joint or subtalar joint pathology. The advantages of endoscopic hindfoot surgery over open surgery are less morbidity, reduction of postoperative pain, outpatient treatment, and functional postoperative treatment. Optimal portal placement for each indication has been identified in a cadaver study. The approach for the flexor hallucis longus and os trigonum is particularly challenging because of the adjacent neurovascular bundle. A two-portal hindfoot approach with the patient in the prone position offers excellent access to the flexor hallucis longus. The posterior ankle compartment, os trigonum, and subtalar joint can be visualized and treated through this approach. In 240 consecutive procedures, no major complications were reported. The two-portal hindfoot endoscopy approach is a safe, reliable, and exciting method to diagnose and treat a variety of posterior ankle problems. Endoscopic calcaneoplasty for retrocalcaneal bursitis offers a good alternative to open resection. Experienced arthroscopic surgeons will find this technique rewarding.
后足疼痛可由多种病理情况引起，其中大多数情况可通过内镜进行诊断和治疗。主要适应证包括胫后肌腱滑膜切除术、腓骨短肌纵行断裂的诊断、腓骨肌腱粘连松解术、拇长屈肌松解术、距三角骨切除术、跟腱后滑囊炎的内镜治疗、跟腱（周围）腱病的内镜治疗以及踝关节或距下关节病变的治疗。与开放手术相比，内镜下后足手术的优点是发病率较低、术后疼痛减轻、可门诊治疗以及术后功能恢复良好。在一项尸体研究中已确定了每种适应证的最佳入路位置。由于相邻的神经血管束，拇长屈肌和距三角骨的入路尤其具有挑战性。患者俯卧位的双入路后足手术方法可很好地显露拇长屈肌。通过该方法可观察和处理后踝间隙、距三角骨和距下关节。在连续240例手术中，未报告重大并发症。双入路后足内镜手术方法是诊断和治疗各种后踝问题的一种安全、可靠且令人满意的方法。跟腱后滑囊炎的内镜下跟骨成形术是开放切除术的良好替代方法。有经验的关节镜外科医生会发现这项技术很有价值。
