Feng Shi-Ming, Sun Qing-Qing, Wang Ai-Guo, Fan Jia-Qiang
Orthopaedic Surgeon, Orthopaedic Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China; Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Orthopaedic Surgeon, Orthopaedic Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, China.
J Foot Ankle Surg. 2020 Nov-Dec;59(6):1197-1200. doi: 10.1053/j.jfas.2020.05.014. Epub 2020 Jun 9.
This study aimed to evaluate the surgical technique and long-term clinical outcomes of all-inside arthroscopic treatment for flexor hallucis longus (FHL) tendon impingement syndrome. We retrospectively evaluated 34 FHL tendon impingement syndrome patients with complete follow-up data who were admitted from June 2015 to August 2018 and underwent the all-inside arthroscopy technique. The subjects consisted of 20 (58.82%) males and 14 (41.18%) females, with a mean age of 32.7 ± 10.2 (range 21-52) years. The cases consisted of 19 (55.88%) right and 15 (44.12%) left feet. The mean disease duration was 18.5 ± 9.1 (range 10-43) months. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS), Karlsson Ankle Functional Score (KAFS), and 36-item Short Form Health Survey questionnaire (SF-36) scores for pain were 3.6 ± 1.2, 84.1 ± 9.6, 86.3 ± 10.7, and 94.7 ± 9.3, respectively. All patients were treated with all-inside posterior arthroscopy for the debridement of the FHL tendon sheath combined with partial muscle belly resection. Post-operative follow-up and observation of the patients' pain and ankle movement were evaluated using VAS, AOFAS, KAFS, and SF-36. All incisions were healed in the first stage, and no complications such as nerve, blood vessel, or tendon injuries occurred. The hospital stays were 3 to 5 days, with a mean of 3.7 ± 1.3 days. All patients were followed up for 12 to 36 months, with a mean follow-up time of 25.4 ± 8.5 months. By the last follow-up, the ankle joint and hallux movement were normal and returned to the pre-pain state for these patients. The VAS score decreased to 0.2 ± 0.1, while the AOFAS, KAFS, and SF-36 scores increased to 97.7 ± 8.5, 97.9 ± 8.2, and 118.2 ± 8.4, respectively. Advantages of all-inside posterior arthroscopic partial muscle belly resection for the treatment of FHL tendon impingement syndrome include small surgical trauma, fast functional recovery, and reliable outcomes. This procedure is therefore worthy of clinical attention and promotion.
本研究旨在评估全关节镜下治疗拇长屈肌腱（FHL）撞击综合征的手术技术及长期临床疗效。我们回顾性评估了2015年6月至2018年8月收治的34例有完整随访数据且接受全关节镜技术治疗的FHL肌腱撞击综合征患者。研究对象包括20例（58.82%）男性和14例（41.18%）女性，平均年龄为32.7±10.2岁（范围21 - 52岁）。病例包括19例（55.88%）右脚和15例（44.12%）左脚。平均病程为18.5±9.1个月（范围10 - 43个月）。视觉模拟评分法（VAS）、美国矫形足踝协会（AOFAS）评分、卡尔森踝关节功能评分（KAFS）以及36项简明健康调查问卷（SF - 36）的疼痛评分分别为3.6±1.2、84.1±9.6、86.3±10.7和94.7±9.3。所有患者均接受全关节镜下后入路手术，清理FHL腱鞘并结合部分肌腹切除术。术后采用VAS、AOFAS、KAFS和SF - 36对患者的疼痛及踝关节活动情况进行随访观察。所有切口均一期愈合，未发生神经、血管或肌腱损伤等并发症。住院时间为3至5天，平均为3.7±1.3天。所有患者均随访12至36个月，平均随访时间为25.4±8.5个月。至末次随访时，这些患者的踝关节及拇趾活动正常，恢复至疼痛前状态。VAS评分降至0.2±0.1，而AOFAS、KAFS和SF - 36评分分别升至97.7±8.5、97.9±8.2和118.2±8.4。全关节镜下后入路部分肌腹切除术治疗FHL肌腱撞击综合征的优点包括手术创伤小、功能恢复快、疗效可靠。因此，该手术值得临床关注和推广。
