关节镜下行踝关节融合术治疗晚期创伤性关节炎11例临床报告  

The Effectiveness of Arthroscopic Ankle Arthrodesis in Patients with Advanced Stage of Traumatic Osteoarthritis

作　　者：张率功[1] 赵德伟[1] 王卫明[1] 刘宇鹏[1] 于晓兵[1] 张春刚[1] 李瑞欣[1] 

机构地区：[1]大连大学附属中山医院骨科,辽宁大连116001

出　　处：《中国运动医学杂志》2011年第2期128-131,共4页Chinese Journal of Sports Medicine

摘　　要：目的:评估关节镜下行踝关节融合术治疗晚期创伤性关节炎的疗效。方法:2006年1月～2009年10月,11例(男8例,女3例)晚期创伤性关节炎患者,年龄45～67岁,平均56岁;9例为外伤引起,2例为习惯性扭伤。均采用关节镜行踝关节融合术,镜下清除踝关节内增生肥厚滑膜,磨削胫骨及距骨表面的关节软骨及其硬化骨,取出游离体,并以两枚松质骨螺钉固定踝关节于屈曲0°,外翻5°～10°,外旋5°～10°及距骨轻度后移位。术后平均随访26周(20周～32周),分别采用Mazur评分系统及Angus and Cowell评价标准比较手术前后评分。结果:11例患者术前Mazur评分平均49.5分,术后平均86.7分(P<0.05)。11例患者术前Angus and Cowell评价标准为差,术后8例优,2例良,1例差(即踝关节未融合患者)。术后患者完全融合时间为11.2周(8周～16周)。融合率为90.9%。1例未达到骨性融合,进行对症治疗未见骨质融合倾向遂取下螺钉并清理钉道溶解骨行自体骨植骨外固定架固定。术后14周时达到骨性融合。结论:关节镜下行踝关节融合术是治疗晚期创伤性关节炎行之有效的方法。Objective To evaluate the effectiveness of arthroscopic ankle arthrodesis in patients with advanced stage of traumatic osteoarthritis in ankle joint.Methods From January 2006 to October 2009,arthroscopic ankle joint arthrodesis was undertaken for 11 patients（8 males and 3 females）with an average age of 56 years（45 to 67 years）.All patients were suffered from advanced stage of traumatic osteoarthritis in ankle joint.Under arthroscope,osteophytes,scar tissue,cartilage and corpus liberums were removed or cleaned up.At the same time two bone screws were used to fix the ankle at 0° flexion,5°~10° eversion,5°~10° external rotation,and slight talus retrodisplacement.The outcome of the arthrodesis was evaluated averagely 26 months after the operation（20 months～32 months）.Mazur scoring system and the Angus and Cowell evaluation criteria for surgery were compared before and after the operation.Results Mazur score improved from 59 points before the operation to 93.4 points after the operation（P 0.05）.According to the protocol of Angus and Cowell,all patients were classified as poor before the operation;and 8 patients were classified as good,2 patients as fair,1 patient as poor（failed fusion）after the operation.Complete fusion averagely took 11.2 weeks（8 weeks-16 weeks）.The overall fusion rate was 90.9%.1 patient had failed in fusion.Conclusion Arthroscopically assisted ankle joint arthrodesis is an effective and safe method for treating advanced stage of traumatic osteoarthritis.

关 键 词：创伤性关节炎 关节镜 踝关节 关节融合 

分 类 号：R687.3[医药卫生—骨科学]