摘要
目的:探讨踝关节源性拇趾腱鞘囊肿的发病机制和行关节镜手术治疗的临床效果。方法:回顾性分析2019年1月至2021年3月于济宁医学院附属医院手足外科行关节镜手术治疗的21例踝关节源性拇趾腱鞘囊肿患者的临床资料。其中男性15例,女性6例,年龄(52.6±8.2)岁(范围:42~70岁);初次手术患者9例,外院术后复发患者12例。所有患者术前均行踝关节造影及MRI检查,术中在踝关节镜下行踝关节滑膜清理、踝管处长屈肌腱腱鞘切除术。术后1年复查MRI,记录术后并发症及复发情况,临床效果评估采用美国足踝骨科学会(AOFAS)前足功能评分及疼痛视觉模拟评分(VAS)。数据比较采用配对样本t检验或Mann-Whitney U检验。结果:21例患者均顺利完成手术,术中可见患者踝关节后关节囊破裂,踝关节内炎性滑膜增生明显,踝后关节囊破裂口与长屈肌腱腱鞘交通。患者术后均未出现切口感染、血管神经损伤等并发症。术后随访(15.0±2.2)个月(范围:12~18个月),随访期间患者趾体外观及术后MRI均无复发表现。末次随访时,AOFAS评分为(90.8±4.3)分,较术前的(72.8±6.3)分明显增加(t=-10.810,P<0.01);VAS为[M(IQR)]1.0(1.0)分,较术前的3.0(0.5)分明显降低,差异有统计学意义(Z=-4.081,P<0.01)。结论:踝关节源性拇趾腱鞘囊肿的发生机制可能为踝关节后方关节囊破裂并与长屈肌腱腱鞘在踝管处交通,关节内滑液通过随长屈肌腱在腱鞘囊滑动产生的唧筒效应,沿着长屈肌腱腱鞘向拇趾趾端聚集,从而出现拇趾腱鞘囊肿。通过踝关节镜下行踝关节滑膜清理、踝管处长屈肌腱腱鞘切除治疗,创伤小、疗效确切。
Objective To investigate the pathogenesis and clinical efficacy of arthroscopic treatment for hallux ganglion cyst deriving from ankle joint.Methods The clinical data of 21 patients with ankle arthroscopic in the Department of Hand and Foot Surgery,Affiliated Hospital of Jining Medical College from January 2019 to March 2021 were analyzed retrospectively.There were 15 male cases and 6 female cases,aged(52.6±8.2)years(range:42 to 70 years).There were 9 cases of primary operation and 12 cases of recurrence after operation in other hospital.All the patients were examined by ankle arthrography and MRI before operation.The synovial membrane of the ankle was debrided and the tendon sheath of flexor longus was removed at the ankle canal.One year after operation,MRI was performed,and the American Orthopedic Foot and Ankle Society(AOFAS)score of forefoot function and visual analogue scale(VAS)before and after operation were compared by the paired t test or Mann-Whitney U test.The postoperative complications and recurrence were recorded.Results All patients were operated successfully.The joint capsule at the back of the ankle joint of the patients were ruptured and communicated with the tendon sheath of the flexor longus tendon at the ankle canal.No wound infection,vascular and nerve injury occurred.The follow-up period was(15.0±2.2)months(range:12 to 18 months).During the follow-up period,there was no recurrence of toe appearance and MRI.At the last follow-up,the AOFAS score(90.8±4.3)was significantly higher than that before operation(72.8±6.3)(t=-10.810,P<0.01),and the VAS score(M(IQR))was significantly lower than that before operation,the difference was significant(1.0(1.0)vs.3.0(0.5),Z=-4.081,P<0.01).Conclusions The possible mechanism of hallux ganglion cyst deriving from ankle joint is that the joint capsule at the back of the ankle joint ruptures and communicates with the tendon sheath of the flexor longus tendon at the ankle canal,and the intra-articular synovial fluid through the cylinder effect generated by sl
作者
张清林
陈磊
韩明通
徐宝强
胡勇
李正勋
Zhang Qinglin;Chen Lei;Han Mingtong;Xu Baoqiang;Hu Yong;Li Zhengxun(Department of Hand and Foot Surgery,Affiliated Hospital of Jining Medical University,Jining 272000,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2023年第11期982-988,共7页
Chinese Journal of Surgery
基金
山东省中医药科技发展项目(2019-0470)
济宁市重点研发计划项目(2022YXNS062)。
关键词
踝关节
关节镜
腱鞘囊肿
踝关节镜
拇趾
长屈肌腱
Ankle joint
Arthroscopes
Ganglion cyst
Hallux
Flexor hallucis
Longus tendon
