Bauer T, Deranlot J, Hardy Ph
Department of Orthopaedic Surgery, Ambroise Paré Hospital, West Paris University, 9, avenue Charles de Gaulle, 92100 Boulogne, France.
Knee Surg Sports Traumatol Arthrosc. 2011 Jan;19(1):131-6. doi: 10.1007/s00167-010-1149-6. Epub 2010 Apr 21.
The calcaneo-fibular impingement syndrome is frequent after calcaneal fracture and is linked to the decreased space between the tip of the fibula and the lateral wall of the calcaneus. The reasons for the painful symptoms are mixed with both bony and soft tissue involvement. The abnormal bony contact between the lateral calcaneal cortex and the tip of the fibula depends mainly on the size and localization of the lateral exostosis of the calcaneal wall. The soft tissue impingement is due to the fibrosis and scar tissues in the lateral gutter and to the compression of the peroneal tendons in the retromalleolar groove and under the tip of the malleolus. A 2-portal endoscopic technique is described for the treatment of calcaneo-fibular impingement with bone resection, soft tissue debridement and peroneal tendons release. One of the advantages of this endoscopic technique is the possibility of an assessment and treatment of associated lesions in the same procedure. A subtalar joint fusion can be done before if needed under arthroscopic control. As this endoscopic technique is very efficient to relieve symptoms of calcaneo-fibular impingement and is focused on the most relevant symptoms, it can thus be indicated for most of cases of calcaneal malunions, whatever the type of malunion and depending of the painful symptoms.
跟腓撞击综合征在跟骨骨折后较为常见，与腓骨尖和跟骨外侧壁之间的间隙减小有关。疼痛症状的原因既有骨组织受累，也有软组织受累。跟骨外侧皮质与腓骨尖之间的异常骨接触主要取决于跟骨壁外侧骨赘的大小和位置。软组织撞击是由于外侧沟内的纤维化和瘢痕组织以及后踝沟和外踝尖下方腓骨肌腱的受压所致。本文描述了一种双入路内镜技术，用于通过骨切除、软组织清创和腓骨肌腱松解来治疗跟腓撞击综合征。这种内镜技术的优点之一是在同一手术中能够评估和治疗相关病变。如有需要，可在关节镜控制下先行距下关节融合术。由于这种内镜技术在缓解跟腓撞击综合征症状方面非常有效，且专注于最相关的症状，因此无论畸形愈合的类型如何，根据疼痛症状，它可适用于大多数跟骨畸形愈合病例。
