Goldberger M I, Conti S F
University Orthopedics, Inc., Pittsburgh, Pennsylvania 15213, USA.
Foot Ankle Int. 1998 Jul;19(7):462-5. doi: 10.1177/107110079801900707.
We investigated the clinical outcomes of patients with specific symptoms and physical findings of subtalar pathology with nonspecific radiographic findings after subtalar arthroscopy. Preoperative workup included plain radiographs in all of the patients, magnetic resonance imaging in seven patients, and bone scan in six patients. Based on these studies, no patient had significant subtalar arthrosis. Twelve patients underwent subtalar arthroscopy. Clinical outcome was rated with the American Orthopaedic Foot and Ankle Society Hindfoot Score. Preoperatively, the score ranged from 54 to 75, with a mean of 60. Postoperative scores ranged from 53 to 85, with a mean of 71. The follow-up averaged 17.5 months. Preoperative magnetic resonance imaging and bone scan uniformly underestimated the degree of articular damage. There were no operative complications. Three patients improved their scores by 10 points or greater. Two of these patients had debridement of a cartilage flap to a stable base performed. The third patient had an arthroscopically assisted removal of a loose body. Three of the four patients whose scores decreased have progressed to subtalar arthrodesis. We conclude from this small series of patients that arthroscopy is the most accurate method of diagnosing subtalar articular cartilage damage, but that it has limited therapeutic benefit in the treatment of early degenerative joint disease.
我们研究了距下关节镜检查后具有距下关节病变特定症状和体征但影像学表现不特异的患者的临床结局。所有患者术前检查均包括X线平片，7例患者进行了磁共振成像检查，6例患者进行了骨扫描。基于这些检查，没有患者存在明显的距下关节病。12例患者接受了距下关节镜检查。临床结局采用美国矫形足踝协会后足评分进行评估。术前评分范围为54至75分，平均为60分。术后评分范围为53至85分，平均为71分。随访平均为17.5个月。术前磁共振成像和骨扫描均一致低估了关节损伤程度。没有手术并发症。3例患者评分提高了10分或更多。其中2例患者进行了将软骨瓣清创至稳定基底的操作。第3例患者进行了关节镜辅助下取出游离体的操作。4例评分降低的患者中有3例已进展为距下关节融合术。从这一小系列患者中我们得出结论，关节镜检查是诊断距下关节软骨损伤最准确的方法，但在治疗早期退行性关节疾病方面其治疗益处有限。
