关节镜治疗顽固性止点性跟腱炎的临床研究

doi:10.3877/cma.j.issn.1674-134X.2026.04.014

目的

探究关节镜在顽固性止点性跟腱炎治疗中的临床效果及安全性。

方法

选取2021年1月～2024年1月深圳平乐骨伤科医院收治的顽固性止点性跟腱炎患者36例为研究对象，均行关节镜下骨赘清理及跟腱松解治疗。记录患者的手术时长、术中出血量、术后负重时间及手术并发症情况，并运用疼痛视觉模拟（VAS）评分表及美国足踝外科协会（AOFAS）踝与后足功能评分标准评价综合疗效。计量资料以

x ¯

±s描述，术前、术后比较采用配对t检验；计数资料以例数表示。P<0.05为差异具有统计学意义。

结果

36例患者均获随访，平均随访时间（6.7±2.0）个月，未出现感染、跟腱断裂等并发症。术后VAS评分（2.3±1.1）分低于术前的（6.3±1.4）分，术后AOFAS评分（92.1±5.9）分高于术前的（76.2±5.8）分，差异均有统计学意义（t=15.683、36.796，均为P＜0.05）。

结论

关节镜治疗顽固性止点性跟腱炎疗效佳、愈合率高、综合疗效好、并发症少，适用于临床推广。

关键词: 关节镜手术, 跟腱, 肌腱病, 微创手术, 治疗结果

Objective

To evaluate the clinical efficacy and safety of arthroscopic treatment for refractory insertional Achilles tendinopathy.

Methods

A retrospective study of 36 patients with refractory insertional Achilles tendinopathy admitted to Shenzhen Pingle Orthopaedic Hospital (Shenzhen Pingshan District Hospital of Traditional Chinese Medicine) between January 2021 and January 2024. All the patients underwent arthroscopic osteophyte debridement and Achilles tendon release. Surgical duration, intraoperative blood loss, postoperative weight-bearing time, and complications were recorded. Clinical outcomes were assessed using the visual analog scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Measurement data were described as mean±standard deviation. The paired-samples ttest was used for within-group comparison between preoperative and postoperative data. Categorical data were presented as cases. The difference was considered statistically significant when P<0.05.

Results

All 36 patients were followed up with an average follow-up time of (6.7±2.0) months. No complications such as infection or Achilles tendon rupture were observed. After operation, VAS score was 2.3±1.1 which was lower than the score 6.3±1.4 before operation; the AOFAS score was 76.2±5.8 which was higher than 92.1±5.9 before operation; the differences were statistically significant (t=15.683, 36.796, both P<0.05).

Conclusion

Arthroscopic treatment for refractory insertional Achilles tendinopathy exhibits positive effects and excellent recovery rate, good postoperative outcomes and minor adverse events, which is certainly worthy of clinical recommendation.

Key words: Arthroscopy, Achilles tenden, Tendinopathy, Minimally invasive surgical procedures, Treatment outcome

表1 疼痛程度及踝关节功能评分比较［n=36，（

x ¯

±s）］

Table 1 Comparison of pain severity and ankle functional scores

时间点 Time point	VAS评分	AOFAS评分
术前 Before operation	6.3±1.4	76.2±5.8
术后 After operation	2.3±1.1	92.1±5.9
MD（95%CI）	4.0（3.5，4.4）	15.9（13.9，18.0）
t值	15.683	-36.796
P值	＜0.001	＜0.001

表1 疼痛程度及踝关节功能评分比较［n=36，（

x ¯

±s）］

Table 1 Comparison of pain severity and ankle functional scores

时间点 Time point	VAS评分	AOFAS评分
术前 Before operation	6.3±1.4	76.2±5.8
术后 After operation	2.3±1.1	92.1±5.9
MD（95%CI）	4.0（3.5，4.4）	15.9（13.9，18.0）
t值	15.683	-36.796
P值	＜0.001	＜0.001

图1 跟腱炎患者术前右足侧位X线片，箭头示Kager三角消失、跟腱止点钙化

Figure 1 Radiograph at lateral view of the right foot of Achilles tendinopathy before operation, the arrow shows obliteration of Kager’s triangle and calcification at the insertion site

图2 跟腱炎患者术前右足三维CT重建，示跟腱止点处部分钙化

Figure 2 Three-dimensional CT reconstruction of the right foot of Achilles tendinopathy before operation, demonstrating partial calcification at the Achilles tendon insertion

图3 跟腱炎患者术前右足跟部矢状位MRI，示跟骨后滑囊水肿、大量炎性组织填充，跟腱部分变性

Figure 3 MRI at sagittal position of the right heel with Achilles tendinopathy before operation, showing retrocalcaneal bursal edema with abundant inflammatory tissue infiltration and partial degeneration of the Achilles tendon

图4 跟腱炎患者术中情况。图A为镜下可见大量滑膜；图B为清理滑膜，暴露骨赘；图C为清理骨赘及钙化部分跟腱；图D为术中透视可见骨赘已清理

Figure 4 Intraoperative findings of Achilles tendinopathy. A is image under arthroscope, showing a large amount of synovium; B is image under arthroscope, showing synovium debridation to expose osteophytes; C is image under arthroscope, showing that osteophytes and calcified portions of the Achilles tendon were removed; D is intraoperative fluoroscopy, showing complete removal of osteophytes

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Clinical study on arthroscopic treatment of refractory insertional Achilles tendinitis

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Clinical study on arthroscopic treatment of refractory insertional Achilles tendinitis