Phisitkul Phinit, Rungprai Chamnanni, Femino John E, Arunakul Marut, Amendola Annunziato
Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
Foot Ankle Int. 2014 Aug;35(8):747-756. doi: 10.1177/1071100714534215. Epub 2014 May 21.
Endoscopic gastrocnemius recession has been proposed as a minimally invasive technique for the treatment of isolated gastrocnemius contracture. We report on the safety and efficacy of endoscopic gastrocnemius recession, as an isolated procedure or combined with other concomitant procedures in terms of improvement in ankle dorsiflexion, functional outcome, and postoperative morbidities.
The data were prospectively collected in this case series. Endoscopic gastrocnemius recession was performed by a single surgeon in 320 consecutive patients (344 feet) who were diagnosed with isolated gastrocnemius contracture and failed nonoperative treatments between March 2009 and December 2012. There were 180 women and 140 men with mean age, 47.1 ± 15.7 years. The minimum follow-up was 1 year (mean, 18 months; range, 12 to 53 months). Pre- and postoperative ankle dorsiflexion, pain (Visual Analog Scale [VAS]), SF-36, and Foot Function Index (FFI) were obtained and compared using paired sample t test and Wilcoxon signed-rank test.
The mean ankle dorsiflexion significantly improved from -0.8 ± 5.4 degrees preoperatively to 11.0 ± 6.6 degrees at average of 13 months postoperatively (n = 294) (P < .001). Complete preoperative and 1-year postoperative pain (VAS) (n = 274) and functional outcome scores (n = 185) were collected when possible. The mean pain (VAS) decreased from 7/10 to 3/10 postoperatively (all P < .01). The mean SF-36 including physical component summary score (PCS) and mental component summary score (MCS) increased from 34 and 44 to 45 and 51, respectively (P < .01 for both PCS and MCS). The mean FFI improved from 63 to 42 for pain, 63 to 43 for disability, 68 to 44 for activity limitation, and 61 to 41 for total score postoperatively (all P < .01). Postoperative morbidity included weakness of ankle plantarflexion (N = 11/320; 3.1% respectively) and sural nerve dysesthesia (N = 10/320; 3.4%). Wound complications or Achilles tendon rupture did not occur. There was no difference in the average improvement in ankle dorsiflexion, outcome scores, and rate of complications between the isolated and combined procedures.
Endoscopic gastrocnemius recession demonstrated promising results in the treatment of isolated gastrocnemius contracture. Ankle dorsiflexion was significantly improved with minimal morbidity. The procedure was found effective in improving functional outcomes and relieving pain as a sole operative treatment and as a part of combined procedures in our patients.
Level IV, case series.
内镜下腓肠肌松解术已被提议作为治疗单纯性腓肠肌挛缩的一种微创技术。我们报告内镜下腓肠肌松解术作为一种单独手术或与其他伴随手术联合应用时，在改善踝关节背屈、功能结局及术后并发症方面的安全性和有效性。
在本病例系列中前瞻性收集数据。2009年3月至2012年12月期间，由一名外科医生对320例连续患者（344足）实施内镜下腓肠肌松解术，这些患者均被诊断为单纯性腓肠肌挛缩且非手术治疗失败。其中女性180例，男性140例，平均年龄47.1±15.7岁。最短随访时间为1年（平均18个月；范围12至53个月）。获取术前和术后的踝关节背屈角度、疼痛程度（视觉模拟评分法[VAS]）、SF-36健康调查简表以及足部功能指数（FFI），并采用配对样本t检验和Wilcoxon符号秩检验进行比较。
平均踝关节背屈角度从术前的-0.8±5.4度显著改善至术后平均13个月时的11.0±6.6度（n = 294）（P <.001）。尽可能收集了术前及术后1年的完整疼痛（VAS）数据（n = 274）和功能结局评分（n = 185）。术后平均疼痛（VAS）从7/10降至3/10（所有P <.01）。平均SF-36健康调查简表包括生理健康综合评分（PCS）和精神健康综合评分（MCS）分别从34和44提高至45和51（PCS和MCS均P <.01）。术后平均FFI在疼痛方面从63改善至42，在残疾方面从63改善至43，在活动受限方面从68改善至44，总分从61改善至41（所有P <.01）。术后并发症包括踝关节跖屈无力（N = 11/320；3.1%）和腓肠神经感觉异常（N = 10/320；3.4%）。未发生伤口并发症或跟腱断裂。单独手术与联合手术在踝关节背屈平均改善程度、结局评分及并发症发生率方面无差异。
内镜下腓肠肌松解术在治疗单纯性腓肠肌挛缩方面显示出良好的效果。踝关节背屈显著改善且并发症极少。该手术作为单独手术治疗以及作为我们患者联合手术的一部分，在改善功能结局和缓解疼痛方面均被证明是有效的。
IV级，病例系列。
