Wan D D, Yuan W J, Hu M Z, Xia Q, Bao Z H
Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin 300192, China.
Zhonghua Yi Xue Za Zhi. 2023 Mar 21;103(11):829-834. doi: 10.3760/cma.j.cn112137-20220813-01736.
To investigate the short-term clinical efficacy of posterior ankle arthroscopy combined with tendoscope on ankle-origin flexor hallucis longus tendon ganglion. A follow-up study. Clinical data of 10 patients with hallux ganglion underwent posterior ankle arthroscopy combined with flexor hallucis longus tendoscope in the Tianjin First Central Hospital from January to June 2021 were analyzed retrospectively. There were 5 males and 5 females with a mean age of 42.7 (22-54) years. Disease distribution: 6 patients were on the right side and 4 cases were on the left side. The mean preoperative course of disease was 19.4 months (2-48 months). The patients were followed-up for a mean time of 12.4 months (8-20 months). The relationship between the origin of hallux ganglion and ankle joint was confirmed by ankle MRI and arthrography of ankle joint before the operation. During the operation, the joint capsule was explored, cleared and opened under the posterior ankle arthroscopy firstly, and then part of the tendon sheath of the forefoot was cleared and cut under the flexor hallucis longus tendoscope. American Orthopedic Foot and Ankle Society (AOFAS) forefoot rating scale and visual analogue scale (VAS) of pain were used to evaluate the clinical outcome before and after operation. Postoperative recurrence, perioperative and long-term complications were recorded spontaneously. The cystic fluid signal of all patients could be traced from flexor hallucis longus tendon to the back of ankle joint by MRI before the operation. Intraoperative radiography showed that contrast media flowed from the back of ankle joint to the end of the hallux. The AOFAS score [(, )] of the patients increased from 70.5(69.0, 87.8) before the operation to 100.0(85.8, 100.0) at the follow-up (=0.002), and at the mean time, the VAS score decreased from 5.0(3.5, 6.0)to 0.5(0.0, 1.3) (<0.001). No complications such as infection and recurrence occurred in all patients until the last follow-up. Posterior ankle arthroscopy combined with minimally invasive technique of tendoscope can treat ankle-origin flexor hallucis longus tendon ganglion effectively.
探讨后踝关节镜联合肌腱镜治疗源于踝关节的拇长屈肌腱腱鞘囊肿的短期临床疗效。一项随访研究。回顾性分析2021年1月至6月在天津市第一中心医院接受后踝关节镜联合拇长屈肌腱镜治疗的10例拇长屈肌腱腱鞘囊肿患者的临床资料。其中男性5例，女性5例，平均年龄42.7（22 - 54）岁。病变分布：右侧6例，左侧4例。术前平均病程19.4个月（2 - 48个月）。患者平均随访时间为12.4个月（8 - 20个月）。术前通过踝关节MRI及踝关节造影确定拇长屈肌腱腱鞘囊肿的起源与踝关节的关系。手术中，先在后踝关节镜下探查、清理并打开关节囊，然后在拇长屈肌腱镜下清理并切除部分前足腱鞘。采用美国矫形足踝协会（AOFAS）前足评分量表及视觉模拟疼痛评分（VAS）对手术前后的临床疗效进行评估。自发记录术后复发情况、围手术期及远期并发症。术前MRI显示所有患者的囊液信号可从拇长屈肌腱追踪至踝关节后方。术中造影显示造影剂从踝关节后方流向拇趾末端。患者的AOFAS评分[（，）]从术前的70.5（69.0，87.8）提高至随访时的100.0（85.8，100.0）（=0.002），同时VAS评分从5.0（3.5，6.0）降至0.5（0.0，1.3）（<0.001）。直至最后一次随访，所有患者均未发生感染、复发等并发症。后踝关节镜联合肌腱镜微创技术可有效治疗源于踝关节的拇长屈肌腱腱鞘囊肿。
