青少年症状性腓下骨合并痛风性踝关节炎的手术治疗△

Surgical treatment for symptomatic os subfibulare accompanied with gouty ankle arthritis in the teenagers

摘要:

[目的]探讨青少年症状性腓下骨合并痛风性踝关节炎的手术疗效。[方法]回顾性分析 2018 年 2 月—2019 年 8 月本科收治的症状性腓下骨合并痛风性踝关节炎 15 例患者的临床资料。男 10 例，女 5 例，左侧 8 例，右侧 7 例，年龄 14~18 岁，平均 (15.73±1.03) 岁。所有患者均采用踝关节镜下清理、腓下骨切除、Brostr?m-Gould 术联合人工线带加强修复距腓前韧带。比较手术前后疼痛视觉模拟评分 (visual analogue scale, VAS) 和美国足踝外科协会 (American Orthopedic Foor & Ankle Society, AOFAS)踝与后足评分。[结果]所有患者顺利完成手术，无神经、血管损伤等严重并发症，术后切口均一期愈合。15 例患者获得随访，随访时间 12~18 个月，平均 (15.25±6.20) 个月。术后 VAS 评分和 AOFAS 踝-后足评分均较术前明显改善， 差异均有统计学意义 (P＜0.05)。[结论] 对于症状性腓下骨合并痛风性踝关节炎患者，采用踝关节镜下清理、腓下骨切除、 Brostr?m-Gould 术联合人工线带加强修复距腓前韧带，可以有效减轻症状，可早期开始踝关节的康复锻炼。

Abstract:

[Objective] To explore the clinical outcomes of combined surgical procedures for symptomatic os subfibulare with gouty an- kle arthritis in the teenagers. [Methods] A total of 15 teenaged patients with symptomatic os subfibulare accompanied with gouty ankle ar- thritis underwent arthroscopic debridement, os subfibulare resection, and Brostr?m-Gould procedure with Internal Brace to strengthen the repair of anterior talofibular ligament from February 2018 to August 2019. The patients included 10 males and 5 females, aged 14~18 years with a mean of (15.73±1.03) years. The VAS score and AOFAS score were used to evaluate the postoperative function of the ankle. [Results] All the patients had operation performed smoothly, without serious complications, and got incisions healed well. The followed up peri- od lasted for12~18 months with a mean of (15.25±6.20) months. Compared with those preoperative, the VAS and AOFAS scores significant- ly improved at the latest follow-up. [Conclusion] For symptomatic os subfibulare with gouty ankle arthritis in the teenagers, arthroscopic debridement, os subfibulare resection, Brostr?m-Gould procedure with Internal Brace artificial ligament to strengthen the repair of anterior talofibular ligament does effectively reduce the symptoms, and get early rehabilitation