Ahn Jae Hoon, Park Dojoon, Park Yong Taek, Park Joonyoung, Kim Yoon-Chung
1 Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
2 Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Orthop Surg (Hong Kong). 2019 Sep-Dec;27(3):2309499019862502. doi: 10.1177/2309499019862502.
Ankle arthroscopy has been used as a standard tool by foot and ankle surgeons. To overcome the narrowness of ankle joint, a noninvasive distraction technique is used for the successful visualization in ankle arthroscopy. The aim of this study was to investigate the incidence and type of complications associated with ankle arthroscopy using a noninvasive distraction technique and to report a troublesome complication.
We reviewed 514 patients' charts from 2003 to 2011. The same noninvasive distraction technique was used. Patients' demography, duration of follow-up, diagnoses, procedures, and complications related to ankle arthroscopy were analyzed.
There were 388 male and 126 female; mean age was 37.2 years; mean follow-up duration was 33 months. The diagnoses were osteochondral lesion of talus, chronic ankle instability, anterolateral soft tissue impingement syndrome, and anterior bony impingement. We performed arthroscopic synovectomy, osteochondral procedure, bony spur excision, and loose body removal. The mean time of arthroscopic procedure was 47 min. There were neurologic complications (eight cases), skin necrosis of posterior thigh (three cases), instrument breakage (two cases), and superficial wound infection (one case). All complications were well resolved. The total duration of distraction plus tourniquet inflation exceeded 120 min in the three cases of skin necrosis. Skin necrosis was deemed to be resulted from the long tourniquet time.
The noninvasive distraction technique is safe and effective for ankle arthroscopy. However, the distraction plus tourniquet requires attention because it can cause high pressure on posterior thigh resulting in soft tissue injury.
踝关节镜已被足踝外科医生用作标准工具。为克服踝关节的狭窄，一种非侵入性牵张技术被用于踝关节镜检查中的成功可视化。本研究的目的是调查使用非侵入性牵张技术的踝关节镜相关并发症的发生率和类型，并报告一种棘手的并发症。
我们回顾了2003年至2011年514例患者的病历。使用相同的非侵入性牵张技术。分析了患者的人口统计学、随访时间、诊断、手术操作以及与踝关节镜相关的并发症。
男性388例，女性126例；平均年龄37.2岁；平均随访时间33个月。诊断包括距骨骨软骨损伤、慢性踝关节不稳、前外侧软组织撞击综合征和前方骨性撞击。我们进行了关节镜下滑膜切除术、骨软骨手术、骨赘切除和游离体取出。关节镜手术的平均时间为47分钟。出现了神经并发症（8例）、大腿后侧皮肤坏死（3例）、器械断裂（2例）和浅表伤口感染（1例）。所有并发症均得到妥善解决。在3例皮肤坏死病例中，牵张加止血带充气的总时长超过了120分钟。皮肤坏死被认为是由于止血带使用时间过长所致。
非侵入性牵张技术对于踝关节镜检查是安全有效的。然而，牵张加止血带操作需要引起注意，因为它可能会对大腿后侧造成高压，导致软组织损伤。
