PDF(Pubmed)
Abstract：
UNASSIGNED: Os trigonum and Stieda process are common etiologies for posterior ankle impingement syndrome (PAIS), and diagnosis is typically made by radiographs, computed tomographic, or magnetic resonance imaging. However, these static tests may not detect associated soft tissue and bony pathologies. Posterior ankle and hindfoot arthroscopy (PAHA) is dynamic, providing at least ×8 magnification with full anatomical visualization. The primary aim of this study was to report the prevalence of associated conditions seen with trigonal impingement treated with PAHA.
UNASSIGNED: In this retrospective comparative study, patients who underwent PAHA for PAIS due to trigonal impingement, from January 2011 to September 2016, were reviewed. Concomitant open posterior procedures and other indications for PAHA were excluded. Demographic data were collected with pre- and postoperative diagnosis, arthroscopic findings, type of impingement, location, associated procedures, and anatomical etiologies. Trigonal impingements were divided in os trigonal or Stieda and subgrouped as isolated, with flexor hallucis longus (FHL) disorders, with FHL plus other impingement, and with other impingement lesions.
UNASSIGNED: A total of 111 ankles were studied-74 os trigonum and 37 Stieda. Isolated trigonal disorders accounted for 15.3% of PAIS (n = 17). Cases having associated conditions had a mode of 3 additional pathologies. FHL disorders were found in 69.4%, subtalar impingement in 32.4%, posteromedial ankle synovitis in 25.2%, posterolateral ankle synovitis in 22.5%, and posterior inferior tibiofibular ligament impingement in 19.8% of cases. Associated pathologies were observed in 58.6% of cases when FHL was not considered. Significant differences were noted comparing os and Stieda (isolated: 20.3% to 5.4%, P = .040; FHL plus others: 35.1% to 59.5%, P = .015).
UNASSIGNED: Trigonal bone (os trigonum or Stieda) was found to cause impingement in isolation in a small proportion of cases even when the FHL was considered part of the same disease spectrum. This should alert surgeons when considering removing trigonal impingement. Open approaches may limit the visualization and assessment of associated posterior ankle and subtalar pathoanatomy, thus possibly overlooking concomitant causes of PAIS.
UNASSIGNED: Level III, retrospective comparative study.
UNASSIGNED: In this retrospective comparative study, patients who underwent PAHA for PAIS due to trigonal impingement, from January 2011 to September 2016, were reviewed. Concomitant open posterior procedures and other indications for PAHA were excluded. Demographic data were collected with pre- and postoperative diagnosis, arthroscopic findings, type of impingement, location, associated procedures, and anatomical etiologies. Trigonal impingements were divided in os trigonal or Stieda and subgrouped as isolated, with flexor hallucis longus (FHL) disorders, with FHL plus other impingement, and with other impingement lesions.
UNASSIGNED: A total of 111 ankles were studied-74 os trigonum and 37 Stieda. Isolated trigonal disorders accounted for 15.3% of PAIS (n = 17). Cases having associated conditions had a mode of 3 additional pathologies. FHL disorders were found in 69.4%, subtalar impingement in 32.4%, posteromedial ankle synovitis in 25.2%, posterolateral ankle synovitis in 22.5%, and posterior inferior tibiofibular ligament impingement in 19.8% of cases. Associated pathologies were observed in 58.6% of cases when FHL was not considered. Significant differences were noted comparing os and Stieda (isolated: 20.3% to 5.4%, P = .040; FHL plus others: 35.1% to 59.5%, P = .015).
UNASSIGNED: Trigonal bone (os trigonum or Stieda) was found to cause impingement in isolation in a small proportion of cases even when the FHL was considered part of the same disease spectrum. This should alert surgeons when considering removing trigonal impingement. Open approaches may limit the visualization and assessment of associated posterior ankle and subtalar pathoanatomy, thus possibly overlooking concomitant causes of PAIS.
UNASSIGNED: Level III, retrospective comparative study.
摘要：
■三角和Stieda过程是后踝关节撞击综合征（PAIS）的常见病因，诊断通常是通过X光片进行的，计算机断层扫描,或者磁共振成像.然而,这些静态测试可能无法检测到相关的软组织和骨病变。后踝关节镜检查（PAHA）是动态的，提供至少×8的放大倍数与完整的解剖可视化。这项研究的主要目的是报告用PAHA治疗的三角撞击所见的相关疾病的患病率。
■在这项回顾性比较研究中，因三角撞击而接受PAHA治疗的患者，2011年1月至2016年9月，进行了回顾。排除了伴随的开放后路手术和其他PAHA适应症。人口统计学数据收集与术前和术后诊断，关节镜检查结果，撞击类型,location,相关程序，和解剖学病因。三角冲击分为三角或Stieda，并分为孤立组，长屈肌（FHL）障碍，FHL加上其他冲击，以及其他撞击损伤。
■共研究了111个脚踝-74个三角和37个Stieda。孤立的三角障碍占PAIS的15.3％（n=17）。具有相关病症的病例具有3种额外病理的模式。在69.4%的患者中发现了FHL疾病，距下撞击占32.4%，后内侧踝关节滑膜炎占25.2%,踝关节后外侧滑膜炎占22.5%,和后下胫腓骨韧带撞击的病例占19.8%。当不考虑FHL时，在58.6％的病例中观察到相关病理。比较OS和Stieda，发现了显着差异（分离：20.3％至5.4％，P=.040；FHL加上其他：35.1%至59.5%，P=.015）。
■即使FHL被认为是同一疾病谱的一部分，在一小部分病例中发现三角骨（ostrigonum或Stieda）也会单独造成撞击。当考虑去除三角撞击时，这应该提醒外科医生。开放入路可能会限制相关的后踝和距下病理解剖的可视化和评估，因此可能忽略了PAIS的伴随原因。
■三级,回顾性比较研究。
■在这项回顾性比较研究中，因三角撞击而接受PAHA治疗的患者，2011年1月至2016年9月，进行了回顾。排除了伴随的开放后路手术和其他PAHA适应症。人口统计学数据收集与术前和术后诊断，关节镜检查结果，撞击类型,location,相关程序，和解剖学病因。三角冲击分为三角或Stieda，并分为孤立组，长屈肌（FHL）障碍，FHL加上其他冲击，以及其他撞击损伤。
■共研究了111个脚踝-74个三角和37个Stieda。孤立的三角障碍占PAIS的15.3％（n=17）。具有相关病症的病例具有3种额外病理的模式。在69.4%的患者中发现了FHL疾病，距下撞击占32.4%，后内侧踝关节滑膜炎占25.2%,踝关节后外侧滑膜炎占22.5%,和后下胫腓骨韧带撞击的病例占19.8%。当不考虑FHL时，在58.6％的病例中观察到相关病理。比较OS和Stieda，发现了显着差异（分离：20.3％至5.4％，P=.040；FHL加上其他：35.1%至59.5%，P=.015）。
■即使FHL被认为是同一疾病谱的一部分，在一小部分病例中发现三角骨（ostrigonum或Stieda）也会单独造成撞击。当考虑去除三角撞击时，这应该提醒外科医生。开放入路可能会限制相关的后踝和距下病理解剖的可视化和评估，因此可能忽略了PAIS的伴随原因。
■三级,回顾性比较研究。
