Stražnji sindrom sraza gležnja [Posterior ankle impingement syndrome]

Bojanić, Ivan and Janjić, Tamara and Dimnjaković, Damjan and Križan, Sanja and Smoljanović, Tomislav (2015) Stražnji sindrom sraza gležnja [Posterior ankle impingement syndrome]. Liječnički vjesnik, 137 (3-4). pp. 109-115. ISSN 0024-3477

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Abstract

Posterior ankle impingement syndrome (PAIS) is a clinical syndrome characterized by posterior ankle pain which occurs in maximal forced plantar flexion of the foot. PAIS can be the result of an acute injury of the ankle, which is more often in general population, or it can be the result of the overuse syndrome, which is more often in athletes and ballet dancers. The etiology of PAIS may involve bony structures or soft tissue structures, or, more often, the combination of both. The diagnosis of PAIS is based on patient's clinical history and physical examination with the hyperplantarflexion test as a very important part of it. Physical examination should be completed with imaging techniques, which most often include magnetic resonance imaging (MRI) or computed tomography (CT) to confirm the diagnosis of PAIS. Conservative treatment is recommended as the primary treatment strategy. In those cases where 3 to 6 months of conservative treatment fails, open or, more often, arthroscopic/endoscopic surgery may be recommended. Nowadays, a 2-portal endoscopic approach introduced by van Dijk et al. in 2000 is the method of choice for the treatment of posterior ankle impingement syndrome.

Abstract in Croatian

Stražnji sindrom sraza gležnja (SSSG) klinički je entitet koji se očituje pojavom boli u stražnjem dijelu gležnja u trenutku maksimalno izvodive plantarne fleksije stopala. SSSG može biti posljedica akutne ozljede gležnja, što je češće u općoj populaciji, ili posljedica sindroma prenaprezanja, što se češće javlja u sportaša i balerina. Uzroci nastanka SSSG-a mogu biti ili koštani ili mekotkivni, ali najčešće je riječ o kombinaciji jednih i drugih. Dijagnoza SSSG-a zasniva se na anamnezi i kliničkom pregledu, u kojemu je test hiperplantarne fleksije ključan. Kako bi se potvrdila postavljena sumnja na SSSG, klinički pregled uvijek valja nadopuniti slikovnim pretragama, i to najčešće magnetskom rezonancijom (MR) ili kompjutoriziranom tomografijom (CT). Nakon što je postavljena dijagnoza SSSG-a liječenje valja započeti neoperacijskim metodama. Ako nakon 3 do 6 mjeseci neoperacijsko liječenje ne da željene rezultate, savjetuje se kirurško liječenje otvorenim pristupom ili, češće, artroskopskim/endoskopskim metodama. Danas je metoda izbora za kirurško liječenje endoskopski zahvat koji su opisali van Dijk i sur. 2000. godine.

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