环锯切骨融合距舟关节治疗距舟关节疼痛  

Trephine transcutaneous osteotomy of talonavicular arthrodesis in the treatment of talonavicular pain

作　　者：刘华永[1] 段升军[1] 栾涛[2] 刘士懂[1] 谢新敏[1] 李强[1] 

机构地区：[1]济南市第三人民医院骨科,济南250101 [2]济南烟草职工医院

出　　处：《中华骨科杂志》2011年第7期734-738,共5页Chinese Journal of Orthopaedics

摘　　要：目的评价环锯切骨融合距舟关节治疗距舟关节疼痛的临床效果及对邻近关节的影响。方法1999年6月至2009年6月，对应用环锯切骨融合距舟关节治疗距舟关节疼痛的24例资料完整患者进行回顾性分析，男13例，女11例；年龄37-72岁，平均45岁；创伤后距舟关节炎15例，风湿性关节炎6例，退变性关节炎3例。应用美国足踝关节协会（AOFAS）踝一后足评分、视觉模拟评分（visual analogue scale，VAS）、Graves评分对患足功能、疼痛及对周围关节的影响进行评价。结果24例患者均获得随访，随访时间10-120个月，平均48个月。术后1例患者出现足部刀口皮肤边缘坏死，经换药延迟拆线3周愈合。AOFAS评分从术前平均45．2分提高至术后平均84．5分，术后优良率为87．5％；VAS疼痛评分从术前8．1分下降至术后2．4分。患者主观在疼痛感受、外观变化、行走距离、穿鞋体验方面均有改善。23例患者对手术效果表示满意，仅有1例患者不满意。术后6个月影像学检查显示23例完全融合（成功率95．8％），1例未融合患者使用大一号环锯经取髂骨骨柱回植融合。Graves评分显示1度改变8例，2度改变l例。结论环锯切骨融合距舟关节创伤小、融合效果满意，对治疗单纯性距舟关节疼痛性病变可取得满意的临床效果。Objective To evaluate the clinical effect of talonavicular arthrodesis and the influence of adjacent joints use trephine percutaneous osteotomy in the treatment of talonavicular arthralgia. Methods From June 1999 to June 2009, 24 patients were performed talonavicular arthrodesis due to a variety of painful disorder of talonavicular joint with trephine percutaneous osteotomy. There were 13 males and 11 females, with an average age of 45 years （range, 37-72 years）. The indications for the procedure included 15 cases with posttraumatic arthritis, 6 cases with rheumatoid arthritis, and 3 cases with degenerative arthritis. AOFAS system and visual analogue scale （VAS） were used to evaluate the change of function and arthralgia. Graves score system was used to evaluate the influence of adjacent joints. Results All patients were followed up 10-120 months, with the mean of 48 months. Only one case suffered skin brim necrosis of incision and got delayed healing after 3 weeks. The average AOFAS ankle-hind foot score improved from 45.2 points preoperatively to 84.5 points postoperatively. The excellent and good rate was 87.5%. VAS pain scores decreased from 8.1 to 2.4 postoperatively. Twenty-three patients were satisfied and one dissatisfied with the results. Postoperative radiology showed the union evidence in 23 patients at 6 months postoperatively （successful fusion rate of 95.8%）. One joint nonunion occurred and required revision arthrodesis with iliac crest bone graft. There was an increase of I grade in arthritic scores for 8 cases and II grade for 1 case. Conclusion Talonavicular arthrodesis with trephine percutaneous osteotomy has the advantages of low trauma, high successful fusion rate and can acquire satisfactory clinical effect in the treatment of painful malalignment of talonavicular joints.

关 键 词：关节融合术 距骨 舟骨 疼痛 

分 类 号：R684[医药卫生—骨科学]