Wei Min, Liu Yang, Wei Yu
Department of Orthopaedics, the Chinese PLA General Hospital, Beijing, 100853,
Department of Orthopaedics, the Chinese PLA General Hospital, Beijing, 100853, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Feb 15;31(2):150-154. doi: 10.7507/1002-1892.201609054.
To evaluate the effectiveness of arthroscopic debridement and release for post-traumatic arthritis of subtalar joint.
Between January 2011 and December 2014, 14 cases of post-traumatic arthritis of the subtalar joint underwent arthroscopic debridement and release, and the clinical data were retrospectively analyzed. All patients were male, aged 42 years on average (range, 32-62 years). Calcaneus fracture was caused by falling from height; 8 cases received conservative treatment and the other 6 cases received open reduction and internal fixation. The mean interval from injury to operation was 3.4 years (range, 2-7 years). The arthroscopic debridement and release were performed through lateral portals. The injury degree of articular cartilage was classified as grade 3 in 4 cases and grade 4 in 10 cases based on Outerbridge rating. The degree of pain was assessed by visual analogue scale (VAS) and the function of joint was assessed by the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale.
All incisions healed by first intention and no complication occurred. The follow-up time was 18 months. Pain was relieved obviously; VAS was significantly decreased to postoperative 3.8±0.9 at 18 months from preoperative 7.7±1.2 ( =9.728, =0.000), and AOFAS Ankle Hindfoot Scale was significantly increased to postoperative 59.1±8.8 from preoperative 37.6±8.2 ( =6.688, =0.000). During follow-up, no patient was given arthrodesis and no worsened sign was found on the postoperative CT and MRI.
Arthroscopic debridement and release for post-traumatic arthritis of the subtalar joint can relieve clinical symptoms and delay subtalar arthrodesis.
评估关节镜下清创及松解术治疗距下关节创伤性关节炎的疗效。
回顾性分析2011年1月至2014年12月间14例接受关节镜下清创及松解术治疗的距下关节创伤性关节炎患者的临床资料。所有患者均为男性，平均年龄42岁（范围32 - 62岁）。跟骨骨折由高处坠落所致；8例接受保守治疗，另外6例接受切开复位内固定治疗。受伤至手术的平均间隔时间为3.4年（范围2 - 7年）。关节镜下清创及松解术通过外侧入路进行。根据Outerbridge分级，关节软骨损伤程度为3级的有4例，4级的有10例。采用视觉模拟评分法（VAS）评估疼痛程度，采用美国矫形足踝协会（AOFAS）踝与后足评分量表评估关节功能。
所有切口均一期愈合，无并发症发生。随访时间为18个月。疼痛明显缓解；VAS评分从术前的7.7±1.2显著降至术后18个月的3.8±0.9（t = 9.728，P = 0.000），AOFAS踝与后足评分量表评分从术前的37.6±8.2显著提高至术后的59.1±8.8（t = 6.688，P = 0.000）。随访期间，无患者接受关节融合术，术后CT及MRI检查未发现病情恶化迹象。
关节镜下清创及松解术治疗距下关节创伤性关节炎可缓解临床症状并延缓距下关节融合术的施行。
