逆行髓内钉胫距跟关节融合治疗胫距、距下关节创伤性关节炎  

Treatment of posttraumatic tibiotalar and talocaicaneal arthritis with tibiotalocaicaneal arthrodesis plus retrograde intramedullary nail

作　　者：施忠民[1] 谢雪涛[1] 张长青[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤杂志》2008年第5期347-349,共3页Chinese Journal of Trauma

摘　　要：目的探讨应用逆行髓内钉行胫距跟关节融合术治疗合并胫距、距下关节严重创伤性关节炎的临床疗效。方法自2003年6月至2006年6月，应用逆行髓内钉行胫距跟关节融合术治疗合并胫距、距下关节创伤性关节炎患者17例，术后疗效评估采用美国足踝外科协会（AOFAS）踝-后足功能评分标准。结果14例术后获得随访，时间6～23个月，平均14．6个月。12例（86％）功能在术后平均11．6周（8～19周）达到骨性愈合，2例（14％）出现延迟愈合（17～19周），其中早期手术的2例（12％）诉足跟进针点疼痛；AOFAS踝一后足功能评分从术前的47分（43～55分）提高到术后的75分（69～86分）。结论逆行髓内钉胫距跟关节融合术是临床治疗踝关节和距下关节严重创伤性关节炎的一种有效方法，能有效缓解踝与后足疼痛，提高生活质量。Objective To investigate the clinical outcome of tibiotalocalcaneal arthrodesis plus retrograde intramedullary nail in treatment of severe posttraumatic tibiotalar and talocalcaneal arthritis. Methods A total of 17 cases of severe posttraumatic tibiotalar and subtalar arthritis were treated with tibiotalocalcaneal arthrodesis plus retrograde intramedullary nail between June 2003 and June 2006. Patients were evaluated by a standardized follow-up examination using ankle-hindfoot scale of the American Orthopedic Foot ＆ Ankle Society （OFAS） score. Results Of all, 14 cases were followed up postoperatively, with a mean follow -up period of 14.6 months （6-23 months）. Bony fusion was achieved in 12 cases （86%） after an average of 11.6 weeks （8-19 weeks） but a delayed union in 2 after 17-19 weeks. Two cases （ 12% ） complained heel pain at the nail entry point at initial stage of operation. The average anklehindfoot score improved from 47 points （43-55 points） preoperatively to 75 points （ 69-86 points） postoperatively. Conclusion Tibiotalocalcaneal arthrodesis plus retrograde intramedullary nailing is proved to be effective in treating severe posttraumatic tibiotalar and talocalcaneal arthritis by marked relief from pain and improvement of life quality.

关 键 词：跟骨 关节炎 创伤性 骨折固定术 髓内 胫距跟关节融合 

分 类 号：R687.3[医药卫生—骨科学]