Tasto James P
Department of Orthopedics, University of California, San Diego, San Diego, California, USA.
Instr Course Lect. 2006;55:555-64.
Subtalar arthroscopy has become a valuable adjunct to the tools used in lower extremity surgery. For the past 25 years, ankle arthroscopy has been in vogue for treating a variety of conditions. Subtalar arthroscopy has more treatment limitations and is more technically difficult to perform than ankle arthroscopy because of the anatomic confines and structure of the subtalar joint. Most procedures are performed on the posterior aspect of the subtalar joint. The subtalar joint is composed of three articulations (posterior, middle, and anterior facets) and is surrounded by a variety of intra-articular and extra-articular ligaments, whose anatomy must be fully understood before attempting this procedure. Subtalar arthroscopy may be indicated for diagnostic purposes and for débridement of synovial impingement syndromes in the sinus tarsi. It may be used to examine loose bodies or osteochondral lesions, to address fractures of the lateral process of the talus, and to evaluate subtalar instability to determine appropriate stabilization methods. Arthroscopic subtalar arthrodesis also has gained credibility over the past 10 years as an acceptable surgical procedure. Arthroscopic evaluation of subtalar instability is useful in planning the appropriate stabilization. Subtalar arthroscopy is usually performed with the patient in the lateral decubitus position without traction. Anterior and posterior portals as well as an accessory anterior portal are usually necessary to perform all of the above procedures. Because of the limited confines of the joint, care must be taken to prevent any articular cartilage damage. When performing subtalar arthroscopy in conjunction with ankle arthroscopy, the subtalar arthroscopy should be performed first to avoid excessive extravasation from the ankle arthroscopy, which could obscure entry to the subtalar joint. Complications of subtalar arthroscopy are similar to those encountered in ankle arthroscopy, such as damage to the sural and superficial peroneal nerves.
距下关节镜检查已成为下肢手术工具中一项有价值的辅助手段。在过去25年里，踝关节镜检查一直盛行于治疗多种病症。距下关节镜检查的治疗局限性更多，而且由于距下关节的解剖结构限制，其操作在技术上比踝关节镜检查更困难。大多数手术是在距下关节的后侧进行。距下关节由三个关节面（后、中、前关节面）组成，并被各种关节内和关节外韧带所环绕，在尝试进行该手术之前必须充分了解其解剖结构。距下关节镜检查可用于诊断目的以及清理跗骨窦的滑膜撞击综合征。它可用于检查游离体或骨软骨损伤，处理距骨外侧突骨折，并评估距下关节不稳以确定合适的稳定方法。在过去10年里，关节镜下距下关节融合术作为一种可接受的手术方法也获得了认可。关节镜评估距下关节不稳有助于规划合适的稳定措施。距下关节镜检查通常在患者侧卧位且无牵引的情况下进行。通常需要前、后入路以及一个辅助前入路来完成上述所有操作。由于关节空间有限，必须小心防止任何关节软骨损伤。当与踝关节镜检查联合进行距下关节镜检查时，应先进行距下关节镜检查，以避免踝关节镜检查过多渗血，这可能会使进入距下关节变得困难。距下关节镜检查的并发症与踝关节镜检查类似，如腓肠神经和腓浅神经损伤。
