外踝综合征的病因及解剖学基础

外踝综合征的病因及解剖学基础

李洪恩1

　刘祥清1

　许山山1

　李伟元2

　李国建1

　张印峰1

　彭光军1

　高伟1

　杨荣1

　衡德峰

1

【摘要】　目的:探讨外踝综合征所致外踝部顽固性步行痛及足背外侧麻刺痛的病因、诊疗方法及疗效。方法:对60张成人X 线片的内外踝长度作了测量。内踝平均长15.26±1.56mm ,外踝平均长27.56±3.14mm 。从1989年7月～2004年7月,手术治疗外踝综合征51例56足,施行外踝尖部分切除51例56足;腓骨肌腱鞘及滑膜部分切除术

45例49足(双侧4例);距跟骨外侧隆起的骨折块切除术18例19足;腓肠神经松解及跟外侧支切断术48例53足(双侧5例);外踝过长16例,手术修整过长过大的外踝及切除外踝骨刺9例,解除外踝碰撞和肌腱挤压,松解腓肠

神经。结果:随访47例,随访期4个月～5年10个月,平均9个月,无一例感染,术后外踝步行痛消失,但跟骨骨折后创伤性扁平足未解决15例16足,非创伤性扁平足3例同时行距舟关节融合,恢复了足弓。结论:本病由于踝关节结构紊乱和外踝先天异常引起。以彻底解除病因为目的的手术治疗,简单易行,效果确实可靠。【关键词】　踝关节结构紊乱;外踝综合征;腓肠神经卡压;外踝过长

【中图分类号】　R684.7 【文献标识码】　A 【文章编号】　1671-7163(2005)03-0205-03

The Anatomy and T reatment of Lateral Malleolar Syndrome Li Hongen ,Liu Xiangqing ,Xu Shen ,et al .

(Department of Orthopaedics ,Mineral H ospital of Z aoZhuang ,Shandong 277101)

【Abstracts 】　Objective :T o study the cause of intractable pedestrian pain in the lateral malleolus and numbness pain in the later 2

al instep ,and investigate the diagnosis and curative effect of lateral malleolar syndrome.Methods :The X -ray films of 60adult ’s ankle were observed.The length of the internal malleolus was (15.26±1.56)mm and the lateral malleolus (27.56±3.14)mm on the 51cases of lateral malleolar syndrome and sural nerve compression were treated from July 1989to July 2004.Partial excision of lateral malleolar tip was performed in 51cases (56feet )and partial excision of peroneal tendon sheath and synovial membrane in 45cases (49feet );The lateral prominent bone mass was cut off after the fracture of talus or calcaneus in 18cases (19feet );the sural nerve was loosend and the lateral calcanean branches cut in 48cases (53feet ).The lateral malleolar impingement and tendon squeezing were relieved ;the mecism and oversize of the lateral malleolus were reconditioned in 16cases.R esults :47cases were followed up for 4～70m onths ,9m onths on the average.N one was in fected.The pedestrain pain in the lateral malleolus disappeared after operation ,but the flatfoot caused by calcaneus fracture remained unres olved.3cases of none traumatic flatfoot received talona 2vicular fusion and the foot arch was reluilt.Conclusion :This disease is caused by anatomical dis order in ankle and congenital later 2al malkolar abnormality.The operation aiming at rem oving pathogenesis is simple and the effect is reliable.

【K ey Words 】　Anatomical dis order in ankle ;Lateral malleolar syndrome ;Sural nerve compression ;Lateral malleolar mecism

收稿日期:2005203217作者单位:1　枣庄矿业集团公司枣庄医院骨科山东枣庄277100

2　山东省文登整骨医院

外踝部顽固性步行痛及足背外侧麻木刺痛是临床比较常见的一种病证。此前临床上一般对此病多采用对症处理或针对性手术治疗,但对此病的内在联系和基本概念尚缺乏系统的认识,特别是该病的发病机理和治疗与解剖学的关系涉及甚少。为此,本文通过15年来对本病51例患者的临床表现,病因调查和治疗经验,并结合X 线片观测,进行如下回顾性分析和总结,供同道参考。1　资料与方法1.1　解剖资料

对60张正常成人(女21张,男39张)踝关节正

位X 线片进行测量。材料来源:收集自1995～2005

年正常成人踝关节正位X 线片60张。测量方法:于

胫骨下端关节面上缘作一水平线,分别从内、外踝尖向该线作垂线,并以此测量内、外踝长度,结果以(x ±s )表示。正常内踝平均长度为(15.26±1.56)mm ,外踝平均长度(27.56±3.14)mm 。同时测算内、外踝长度比例:外踝长度为内踝长度的2倍者5例,占8.3%;外踝长度>内踝长度的2倍者6例,占10%;外踝长度<内踝长度的2倍者49例,占81.7%。1.2　临床资料

1.2.1　一般资料:1989年7月～2004年7月共收治

外踝综合征51例56足,男29例,女22例,年龄17

～66岁,平均34.8岁。41岁以上共13例,约占25.4%。其中,非创伤性扁平足(中度以上)16例(图1),创伤性扁平足15例(16足)(图2),外踝过长