Hasegawa A, Kimura M, Tomizawa S, Shirakura K
Department of Orthopaedic Surgery, Gunma Social Welfare Central General Hospital, Japan.
Clin Orthop Relat Res. 1996 Sep(330):157-65. doi: 10.1097/00003086-199609000-00019.
Sixty ankles of 59 patients with symptomatic ossicles of the lateral malleolus were studied. All patients underwent clinical and radiographic examinations. Stress arthrography was performed on 58, arthroscopy on 48, operative treatment on 52, and histologic examination on 23. The ossicles were classified into 3 sizes (small, medium, and large) and 2 levels (A and B) by location. The relationship between the ossicle and fibular tip was classified into 3 grades according to arthrography results (Grade 1, little inflow [< 1 mm] of the contrast medium; Grade 2, an apparent space [1-2 mm]; Grade 3, a large gap [> 2 mm]) and to operative and arthroscopic findings (Type A, a fibrous union; Type B, a partial continuity; Type C, a lax thin scar tissue; Type D, no continuity). There were significant differences in talar tilt angles on stress radiography between the 3 grades. Chronic symptoms had a tendency to increase from Grade 1 to Grade 3 and from Type A to Type C or D, with instability occurring more than pain. The size and level did not correlate with instability. Acute or chronic inversion forces may act on the connection between the ossicle and fibular tip, and damage to this structure may cause symptoms.
对59例有症状的外踝小骨患者的60个踝关节进行了研究。所有患者均接受了临床和影像学检查。58例患者进行了应力关节造影，48例进行了关节镜检查，52例接受了手术治疗，23例进行了组织学检查。根据位置将小骨分为3种大小（小、中、大）和2个水平（A和B）。根据关节造影结果（1级，造影剂流入少[<1mm]；2级，明显间隙[1 - 2mm]；3级，大间隙[>2mm]）以及手术和关节镜检查结果（A型，纤维连接；B型，部分连续性；C型，松弛的薄瘢痕组织；D型，无连续性），将小骨与腓骨尖的关系分为3级。3级之间应力位X线片上距骨倾斜角有显著差异。慢性症状有从1级到3级以及从A型到C型或D型增加的趋势，不稳定比疼痛更常出现。大小和水平与不稳定无关。急性或慢性内翻力可能作用于小骨与腓骨尖之间的连接，该结构受损可能导致症状。
