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1、例位于前侧及前内侧。术前在MRI检查仅发现7例有软骨损伤,术中关节镜下发现有23例有软骨损伤,原有7例被证实为山〜IV软骨损伤。软骨损伤根据Guhl分度法分为:I度3例、II度5例、山度7例、IV度8例。所有23例距胫关节存在的软骨损伤,其中距骨软骨损伤8例,胫骨软骨损伤5例,距胫关节相对面均存在软骨损伤10例。所有患者术后疼痛均缓解,22例关节疼痛完全缓解,2例活动时疼痛,6例活动后有轻度疼痛,关节肿胀均缓解,踝关节活动功能明显改善。Meislin疗效评估:术前优0例(0%),良5例(16.7%),可8例(26.7%),差仃例(56.
2、7%),优良率16.7%(5/30),术后随访优18例(60%),良9例(30%),可3例(10%),差0例(0%),优良率90%(27/30),手术前后比较差异有统计学意义(Z=6.0445,P=0.000)。AOFAS评分:术前43.3±5.1分(33-51分),术后随访89.8±4.3分(76・95分),手术前后两者比较差异有统计学意义(t=38.1798,P=0.000)oVAS疼痛评分术前6.7±2.3分,术后随访2.8±1.6分,手术前后比较差异有统计学意义(t二7.6241,P=0.000)o所有患者术后均未出现神经和血管
3、损伤,切口均I期愈合,无手术切口及关节腔的感染。结论对踝关节撞击症患者进行关节镜下的撞击复制,可全面了解撞击特点,进一步明确术前诊断。镜下视野全面、清楚,根据撞击的部位、程度及撞击组织进行处理,手术针对性强,处理结果满意,不易遗漏未处理的病灶。手术创伤小、疼痛轻、恢复快、功能恢复满意。关节镜对踝关节撞击症的诊断及治疗有重要的应用价值。关键词踝关节撞击综合征关节镜ClinicalEffectOFArthroscopyOnAnkleImpingementSyndromeAbstractObjectiveExplorearthroscopic
4、displayofankleimpingementsyndrometofurtherclearpreoperativediagnosis,assessmentofdiseaseprognosisandguideclinicaltreatment.Andinaccordancewithmicroscopicsimulationonankleimpact,tounderstandtheexpressionalcharacteristicsofthespecificimpactsite,thedegreeofimpact,theimpacts
5、copeandimpactorganizations,etcsuchasperformancecharacteristics,giventargetedtreatment,toassessitspostoperativeeffect.MehodsRetrospectiveanalysis30casesofankleimpingementclinicaldatafromMarch2009toApril2013,22malesand8femaleswithanaverageageof28.6±5.3years(range,16to55yea
6、rs).Therewere21rightanklesand9leftankles,26caseshaveaclearhistoryofanklesprain.Excludeanklejointpathologicaldiseases,suchasrheumatoidarthritisJointtuberculosisandtumor,goutyarthritis,etc;Excludeobviousankleinstability,whentheirligamentneedrepairorreconstruction;Excludese
7、vereosteoarthritis,acuteanklefracturesandsprainofligament.Patientsdurationof6to62months(mean21±4.3months).BypreoperativeX-ray,6caseswerefoundloosebodiesofanklejointandhyperplasiaand4casesexistedtheoldankleavulsionfractures.AccordingtotheMRIcheck,17casesofanklewereembedde
8、dwithsofttissue,and7caseshadarticularartilaginjuryoftibiotalarjointandbonemaiTowedema.Accordingtoclinic