关节镜手术治疗伴过长跟骨前突的跗骨窦综合征的短期疗效分析

doi:10.3877/cma.j.issn.1674-6899.2026.03.008

目的

探讨关节镜下过长跟骨前突切除联合跗骨窦清理术治疗伴过长跟骨前突的跗骨窦综合征的临床疗效。

方法

回顾性分析2023年9月至2025年9月收治的7例伴过长跟骨前突的顽固性跗骨窦综合征患者的临床资料。所有患者均行关节镜下过长跟骨前突切除联合跗骨窦清理术。记录患者术前及术后1月、3月、6月的美国足踝外科协会(American Orthopaedic Foot and Ankle Society，AOFAS)踝-后足评分、足踝测量评分(foot and ankle outcome score，FAOS)及视觉模拟疼痛评分(visual analogue scale，VAS)，记录感染、皮肤坏死、肌腱损伤或下肢静脉血栓等并发症的发生率、跗骨窦疼痛复发率、恢复活动时间以评估临床效果。

结果

7例患者均顺利完成手术及全程随访。治疗后6个月，患者FAOS评分由42.86±6.84分提升至90.86±4.60分，VAS评分由7.14±1.34分降至1.71±0.76分，AOFAS评分由40.14±4.71分提升至85.29±3.23分。术后所有患者均未出现并发症。末次随访时，所有患者均未复发。

结论

对于伴过长跟骨前突的跗骨窦综合征，关节镜下过长跟骨前突切除联合跗骨窦清理术可显著改善患者足踝功能、缓解疼痛，并发症发生率及复发率低，短期临床疗效满意。

关键词: 跗骨窦综合征, 过长跟骨前突, 关节镜

Objective

To investigate the clinical efficacy of arthroscopic resection of the too-long anterior process (TLAP) of the calcaneus combined with sinus tarsi debridement in the treatment of sinus tarsi syndrome (STS) with a too-long anterior process of the calcaneus.

Methods

A retrospective analysis was conducted on the clinical data of 7 patients with refractory STS with TLAP admitted from Sep. 2023 to Sep. 2025. All patients underwent arthroscopic resection of TLAP combined with sinus tarsi debridement. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, foot and ankle outcome score(FAOS) , and visual analogue scale (VAS) pain score were recorded preoperatively and at 1, 3, and 6 months postoperatively. The incidence of complications including infection, skin necrosis, tendon injury, or deep vein thrombosis of the lower extremity, the recurrence rate of sinus tarsi pain, and the time to return to activity were documented to evaluate the clinical outcomes.

Results

All 7 patients successfully underwent surgery and completed the entire follow-up period. At 6 months after treatment, the patients′ FAOS score increased from 42.86±6.84 to 90.86±4.6, the VAS pain score decreased from 7.14±1.34 to 1.71±0.76, and the AOFAS score improved from 40.14±4.71 to 85.29±3.23. No postoperative complications occurred in any patient. At the final follow-up, no recurrence was observed in any patient.

Conclusion

For STS with TLAP, arthroscopic resection of TLAP combined with tarsal sinus debridement can significantly improve foot and ankle function and relieve pain, with low complication and recurrence rates, yielding satisfactory short-term clinical outcomes.

Key words: Sinus tarsi syndrome(STS), Too-long anterior process(TLAP), Arthroscopy

图1 CT和MRI提示过长跟骨前突(白色箭头)

图3 术后行(A)距下关节关节松动术及(B)跗横关节关节松动术

图2 关节镜下过长跟骨前突切除术注：A.手术入路，包括跗骨窦内侧入路(medial portal, MP)、外侧入路(lateral portal, LP)和背外侧中跗关节入路(lateral midtarsal portal, MLP)；B.透视确认MLP；C.关节镜下见跟骨(calcaneus, Cal)与距骨(talus, Ta)形成的距下关节前关节面，探钩指示TLAP；D：切除TLAP后确认Cal、Ta、骰骨(cuboid, Cu)、舟骨(navicular, Nav)，中跗关节松动；E：术后复查足斜位见TLAP切除满意(白色箭头)

表1 患者术前情况(n＝7)

患者编号	性别	年龄	患侧	病程(月)	术前功能评分
患者编号	性别	年龄	患侧	病程(月)	FAOS	VAS	AOFAS
1	男	33	左	7	38.66	8	33
2	男	27	右	6	44.74	8	37
3	男	49	右	11	46.70	5	39
4	女	28	左	14	40.78	7	40
5	女	23	右	18	51.22	9	41
6	女	33	右	25	30.59	7	43
7	女	46	右	4	47.32	6	48

表1 患者术前情况(n＝7)

患者编号	性别	年龄	患侧	病程(月)	术前功能评分
患者编号	性别	年龄	患侧	病程(月)	FAOS	VAS	AOFAS
1	男	33	左	7	38.66	8	33
2	男	27	右	6	44.74	8	37
3	男	49	右	11	46.70	5	39
4	女	28	左	14	40.78	7	40
5	女	23	右	18	51.22	9	41
6	女	33	右	25	30.59	7	43
7	女	46	右	4	47.32	6	48

表2 患者手术前后功能评分的比较(n＝7)

	FAOS评分			AOFAS评分			VAS评分
		95%置信区间	P值		95%置信区间	P值		95%置信区间	P值
术前	42.86±6.84	－	－	40.14±4.71	－	－	7.14±1.34	－	－
术后1月	69.43±3.78	[19.93, 33.22]	<0.01	64.71±2.83	[19.96，29.19]	<0.01	4.43±0.98	[1.19，4.24]	<0.01
术后3月	82.70±2.14	[33.95，45.76]	<0.01	77.57±1.72	[33.62，41.24]	<0.01	2.71±0.76	[2.59，5.41]	<0.01
术后6月	90.86±4.60	[41.21，54.79]	<0.01	85.29±3.23	[40.21，50.09]	<0.01	1.71±0.76	[4.16，6.70]	<0.01

表2 患者手术前后功能评分的比较(n＝7)

	FAOS评分			AOFAS评分			VAS评分
		95%置信区间	P值		95%置信区间	P值		95%置信区间	P值
术前	42.86±6.84	－	－	40.14±4.71	－	－	7.14±1.34	－	－
术后1月	69.43±3.78	[19.93, 33.22]	<0.01	64.71±2.83	[19.96，29.19]	<0.01	4.43±0.98	[1.19，4.24]	<0.01
术后3月	82.70±2.14	[33.95，45.76]	<0.01	77.57±1.72	[33.62，41.24]	<0.01	2.71±0.76	[2.59，5.41]	<0.01
术后6月	90.86±4.60	[41.21，54.79]	<0.01	85.29±3.23	[40.21，50.09]	<0.01	1.71±0.76	[4.16，6.70]	<0.01

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Arthroscopic resection and debridement for sinus tarsi syndrome with too-long anterior process of the calcaneus: short-term results

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Arthroscopic resection and debridement for sinus tarsi syndrome with too-long anterior process of the calcaneus: short-term results