Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY 10595, USA.
Foot Ankle Int. 2012 Sep;33(9):740-5. doi: 10.3113/FAI.2012.0740.
Ankle arthroscopy has evolved as a diagnostic and therapeutic tool. Traditionally, it is performed with traction because of the tight ankle joint space. Original traction techniques were invasive but have progressed to the commonly used noninvasive modalities. Recent reports have suggested traction may be unnecessary. The purpose of this study was to compare prospectively ankle arthroscopy with and without traction in terms of ease of visualization of anatomic structures according to the Ferkel's ankle arthroscopy criteria.
Under Institutional Review Board approval, 103 patients received ankle arthroscopies, first with noninvasive traction and subsequently without traction. An independent observer scored each arthroscopy based on the 21-point Ferkel's criteria. For each structure adequately visualized, one point was given. Inadequate visualization was defined as excessive force or as visible cartilage scuffing. The maximum possible score was 21 points and the lowest was zero. Fifty-five females and 48 males, average age 35 (range, 16 to 71) years, participated in the study.
Noninvasive traction facilitated visualization of all structures of the anterior ankle in more than 90% of cases except for the anterior compartment and lateral gutters, which were better visualized without traction with the ankle in dorsiflexion. No difference was seen when visualizing the talus. Traction arthroscopy performed better when evaluating the central and posterior ankle. The mean score difference was statistically significant, 11.2 versus 18.5 points, favoring noninvasive traction arthroscopy. The complication rate was 4%.
Noninvasive traction facilitated complete ankle arthroscopy. Dorsiflexion improved visualization of the anterior compartment and lateral ankle gutter. The authors recommend noninvasive traction when performing ankle arthroscopy.
踝关节镜已发展成为一种诊断和治疗工具。由于踝关节间隙紧，传统上需要使用牵引来进行。最初的牵引技术是侵入性的，但已经发展到常用的非侵入性方式。最近的报告表明，牵引可能不是必需的。本研究的目的是根据 Ferkel 踝关节镜标准，前瞻性地比较有牵引和无牵引的踝关节镜检查在解剖结构可视化方面的难易程度。
在机构审查委员会的批准下，103 名患者接受了踝关节镜检查，首先是使用非侵入性牵引，然后是没有牵引。一名独立的观察者根据 21 分的 Ferkel 标准对每个关节镜检查进行评分。对于每个结构都能充分观察到，得 1 分。过度用力或可见软骨擦伤定义为观察不足。最大可能得分为 21 分，最低分为 0 分。55 名女性和 48 名男性，平均年龄 35 岁（范围 16 岁至 71 岁）参与了这项研究。
非侵入性牵引可使前踝的所有结构在 90%以上的情况下得到充分观察，除了前间隔和外侧沟，这些结构在踝关节背屈时不使用牵引观察效果更好。在观察距骨时没有差异。当评估中踝和后踝时，牵引关节镜检查效果更好。平均评分差异具有统计学意义，11.2 分与 18.5 分，有利于非侵入性牵引关节镜检查。并发症发生率为 4%。
非侵入性牵引有助于完成踝关节镜检查。背屈可改善前间隔和外侧踝关节沟的可视化效果。作者建议在进行踝关节镜检查时使用非侵入性牵引。
