关节镜下等离子刀治疗慢性跟腱炎

摘要

目的 探讨关节镜下等离子刀(TOPAZ)微创治疗慢性跟腱炎的疗效.方法 采用局部浸润麻醉,关节镜辅助下等离子刀微创治疗慢性跟腱炎17例,其中男性11例,女性6例;年龄17～48岁.标记跟腱疼痛点,在跟腱两侧病灶以上5 mm处切开皮肤5 mm,插入肌腱剥离器,沿皮下组织与肌腱之间进行钝性分离,制作出20 mm×30 mm的工作腔隙,置入30°关节镜,观察其病理改变.采用微型刨削刀和等离子刀,清理跟腱表面增生杂乱的须状撕裂的腱性纤维组织和增厚的部分腱膜.再将TOPAZ电极置入病灶,启动等离子刀进行局部打孔,深达跟腱在跟骨附着处表面,孔间距离3～5 mm呈网眼状.结果 术后17例获得随访,随访时间9～35个月,平均13个月.术后疼痛症状完全解除15例,疼痛明显改善2例.VAS疼痛评分术前8.7分,术后1.6分.无术中和术后跟腱断裂、感染、血管神经损伤等并发症.结论 关节镜监视下等离子刀微创治疗跟腱炎创伤小,手术操作简便,有利于术后康复,疗效显著.%Objective To evaluate the effectivenss of microtenotomy using a radiofrequency(RF) probe to treat chronieity achilles tendinitis.Methods Seventeen cases of chronicity achilles tendinitis were treated by RF probe.Eleven cases were male,and 6 female.The average age of the patients was 25(17-48)years.Nine were athlete,4 sports activity and 4 students.Seven were in left side,and 10 righit side.Before receiving the RF therapia all patients had achilles tendinitis symptoms.The patients were treated with local anesthesia under arthroscopy by Arthrocare 2000 and TOPAZ.The operation were performed through a manmade lacouna under the subcutaneous tissue of achilles tend,insert arthroscope.The pathology test found the achilles tendon surface fibrous tissue hyperplasia and tear.The probe of RF to perforate just as meshwork,the space was 3-5 mm.Results Patients reported significantly reduced pain from 7 to 14 d postoperatively.The symptoms of pain was completely disappeared in 15,obviously relieve in 2.The functional outcome was assessed using the VAS score evaluation,perioperative 8.7 and postoperative 1.6.There were no perioperative and postoperative complications related to the procedure,as rupture of achilles tendon,blood vessel and nerve injury.No infection and recur was found in the cases.Conclusions RF therapy for chronieity achilles tendinitis under the arthroscopy with minimum invasion is less pain and easy for early rehabilitation.The result is satisfactory.