Moukoko Didier, Henric Nicolas, Gouron Richard, Peyronnet Antoine, Bin Kim
Paediatric Orthopaedic Surgery Angers University Hospital, Angers.
Paediatric Orthopaedic Surgery Unit "Les Fontaines" Clinic, Melun.
J Pediatr Orthop. 2018 Oct;38(9):e524-e529. doi: 10.1097/BPO.0000000000001229.
To evaluate the surgical management of a symptomatic subfibular ossicle after severe ankle sprain with functional instability and pain sequelae in children.
We analyzed 36 patients complaining of functional instability without laxity, 1 year after an ankle inversion trauma associated with the observation of a subfibular ossicle. We systematically suggested the open excision of the residual ossicles, followed by 6 weeks of immobilization and proprioceptive physiotherapy. Seventeen of them, constituting the "resection" group accepted this surgical approach. The remaining 19 patients, the "control" group, received only rehabilitative care. The American Orthopaedic Foot and Ankle Society ankle pain and function score was evaluated in both groups.
The mean latest follow-up was 4 years and 4 months (range, 1 y 8 mo to 14 y 7 mo). A significant improvement of the American Orthopaedic Foot and Ankle Society score was observed and was significantly higher in the resection group with a mean gain of 31 points (SD=31.8), versus 7 points (SD=7) in the control group (P<0.001).
We conclude that in the absence of objective laxity, excision of the os subfibulare appears as a simple and effective technique in the treatment of posttraumatic functional instability and ankle pain.
Level IV-retrospective case-control study.
评估儿童严重踝关节扭伤后出现功能性不稳定和疼痛后遗症时，有症状的腓骨下籽骨的手术治疗方法。
我们分析了36例在踝关节内翻创伤1年后出现功能性不稳定但无松弛的患者，这些患者伴有腓骨下籽骨。我们系统地建议对残留籽骨进行开放性切除，随后进行6周的固定和本体感觉物理治疗。其中17例患者组成“切除”组，接受了这种手术方法。其余19例患者为“对照组”，仅接受康复治疗。对两组患者均评估了美国矫形足踝协会的踝关节疼痛和功能评分。
平均末次随访时间为4年4个月（范围为1年8个月至14年7个月）。观察到美国矫形足踝协会评分有显著改善，切除组的改善更为显著，平均提高31分（标准差=31.8），而对照组平均提高7分（标准差=7）（P< 0.001）。
我们得出结论，在没有客观松弛的情况下，切除腓骨下籽骨似乎是治疗创伤后功能性不稳定和踝关节疼痛的一种简单有效的技术。
IV级——回顾性病例对照研究。
