Park Chul-Hyun, Park Jeong Jin, Woo In Ha, Yan Hongfei, Lee Woo-Chun
Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu 42415, Korea.
Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu 42415, Korea.
J Clin Med. 2022 Oct 21;11(20):6215. doi: 10.3390/jcm11206215.
(1) Background: Little is known about the etiology, clinical features, diagnosis methods, treatments, and the prognosis of synovial fistula of the ankle joint. The purpose of this study is to investigate the clinical features of synovial fistula of the ankle joint. (2) Methods: Between March 2003 and December 2018, 40 cysts associated with synovial fistula of the ankle joint were treated consecutively by two surgeons. Case histories, clinical manifestations, intraoperative findings, surgical treatment methods, and treatment outcomes were evaluated to characterize fistula-associated cysts. The clinical results were assessed using the visual analog scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional scores, preoperatively and at the last follow-up. (3) Results: The main complaints were ankle instability and pain (15 patients), pain only (15 patients), instability (seven patients), and cosmetic problems (three patients). Eleven patients had a cyst with an open skin wound, and eight of these patients had undergone surgery under a misdiagnosis of bursitis. Cysts were located anterior to the lateral malleolus in 22 cases, next to the lateral malleolus in 13 cases, posterior to the lateral malleolus in three cases, and across the entire lateral malleolus in two cases. Mean VAS and AOFAS scores improved from 5.2 (range, from 1 to 7) and 72.3 (range, from 65 to 87) preoperatively to 1.1 (range, from 0 to 3) and 93.6 (range, from 85 to 100), respectively, at final follow-up visits. (4) Conclusions: Cyst occurrence due to a synovial fistula should be considered when treating a cyst around the lateral malleolus. Fistula repair and reinforcement with fibular periosteum provides a good treatment option for cysts attributed to synovial fistula of the ankle that fail to respond to conservative treatment.
（1）背景：踝关节滑膜瘘的病因、临床特征、诊断方法、治疗及预后鲜为人知。本研究旨在探讨踝关节滑膜瘘的临床特征。（2）方法：2003年3月至2018年12月期间，两位外科医生连续治疗了40例与踝关节滑膜瘘相关的囊肿。对病史、临床表现、术中发现、手术治疗方法及治疗结果进行评估，以明确与瘘相关囊肿的特征。术前及末次随访时，采用视觉模拟评分法（VAS）和美国矫形足踝协会（AOFAS）踝-后足功能评分评估临床结果。（3）结果：主要主诉为踝关节不稳及疼痛（15例）、仅疼痛（15例）、不稳（7例）及外观问题（3例）。11例患者囊肿伴有皮肤开放性伤口，其中8例曾被误诊为滑囊炎而接受手术。囊肿位于外踝前22例，外踝旁13例，外踝后3例，横跨整个外踝2例。末次随访时，VAS评分均值从术前的5.2（范围1至7）改善至1.1（范围0至3），AOFAS评分均值从术前的72.3（范围65至87）改善至93.6（范围85至100）。（4）结论：在外踝周围囊肿的治疗中应考虑滑膜瘘导致囊肿的可能性。对于保守治疗无效的踝关节滑膜瘘所致囊肿，瘘修复及腓骨骨膜加固是一种良好的治疗选择。
