跟腱Haglund病手术治疗方式的比较研究

【作者】 焦晨； 胡跃林； 皮彦斌；

【机构】 北京大学第三医院运动医学研究所；

【摘要】 跟腱Haglund病是异常的跟骨后上突与跟腱下滑囊和跟腱组织机械性撞击引起后足疼痛的一种疾病。病理特点为异常突出的跟骨后上突、跟腱下滑囊形成,可合并跟腱的变性、部分撕裂。与跟腱末端病不同的是,后者病变集中于跟腱的跟骨止点,以跟腱止点变性、钙化、骨化为特点。治疗方法也因此各不相同。跟腱Haglund病经过用药、理疗等保守治疗无效后应采用手术治疗。手术治疗主要将突出的跟骨后上突切除,跟腱下滑囊予以切除,并清理相对应的变性的跟腱组织。对于前两项处理,目前越来越多地采用关节镜技术来完成,但尸体研究显示切开手术切除跟骨后上突更完全,即切除线更陡峭、切除骨突更大、剩余的后缘更小、切除滑囊更彻底。对于清理跟腱病变组织,通过关节镜技术完成是有一定困难的。通过对切开和关节镜治疗Haglund病的病例进行随访研究,术前和术后应用VAS、AOFAS、Tegner、VISA-A评分评价临床效果,并两组比较,结果显示关节镜手术的临床效果与切开手术没有明显差异,但切开手术的手术时间明显少于关节镜手术。更多还原

【Abstract】 The Haglund disease of the Achilles tendon is described as impingement of Haglund deformity and the Achilles tendon with pain. The pathological characteristics include Haglund deformity, bursitis and degeneration or tears of tendon. The difference of enthesiopathy from the Haglund disease is the degeneration, calcification or ossification of the insertion of the Achilles tendon and results in the different treatment methods.Surgery is chosen when the conservative treatment failed. The surgical procedures are resection of the Haglund deformity and bursa and debridement of the degenerative tissue of the Achilles tendon. The resection of the Haglund deformity and bursa can be completed under arthroscopy but less thoroughly compared to the open surgery. The debridement of the Achilles tendon is unlikely to be done arthroscopically.We followed up two case series of open and arthroscopic surgery on the Haglund disease and compared the VAS、AOFAS、Tegner、VISA-A scores preoperatively and postoperatively. The outcomes showed no significant difference between two groups. The degree of resection is more thorough and surgical time is less in the open group.更多还原