合并腓骨截骨的踝上截骨治疗内翻型踝关节炎  

Supramalleolar osteotomy with fibular osteotomy in treatment of varus ankle arthritis

作　　者：赵宏谋[1] 梁晓军[1] 李毅[1] 鹿军[1] 王军虎[1] 刘诚[1] 杨杰[1] 

机构地区：[1]西安交通大学医学院附属红会医院足踝外科,710054

出　　处：《中华骨科杂志》2016年第16期1025-1032,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81301604）;陕西省自然科学基础研究项目（2014JQ4164）

摘　　要：目的探讨合并腓骨截骨的踝上截骨术治疗中期内翻型踝关节炎的临床与影像学治疗结果。方法回顾性分析2009年4月至2014年4月采用合并腓骨截骨的踝上截骨治疗内翻型踝关节炎并随访至少1年的22例患者资料，男5例，女17例；年龄37-71岁，平均52．4岁；踝关节炎Takakura分期，Ⅱ期5例，Ⅲa期12例，Ⅲb期5例。采用美国足踝外科协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝与后足评分、Maryland评分、踝关节骨关节炎量表（ankle osteoarthritis scale，AOS）对患者进行临床评估，同时测量比较踝关节屈伸活动度及相关影像学指标，包括胫骨前侧关节面角（tibial anterior surface angle，TAS）、距骨倾斜角（talar tilt angle，TT）、胫骨踝穴角（tibiocrural angle，TC）以及胫骨侧位关节面角（tibial lateral surface angle，TLS）。结果22例患者均获得随访，随访时间17-55个月，平均36．6个月。其中2例延迟愈合，1例因术后疼痛和功能障碍而行踝关节融合术。截骨部位均获骨性愈合，愈合时间3-8个月，平均3．9个月。21例行踝上截骨患者的AOFAS评分、Maryland评分、AOS疼痛与功能评分均较术前有显著改善，AOFAS踝与后足评分平均提高（31．7±12．5）分，Maryland评分平均提高（22．1±11．5）分，AOS疼痛评分和功能评分分别降低（16．1±7.4）分和（15．6±6．9）分。13例（62％）Takakura分期较术前有改善，其中6例由Ⅱ／Ⅲ期改善至Ⅰ期，6例由Ⅲ期改善至Ⅱ期，1例由Ⅲb期改善至Ⅲa期。踝关节屈伸活动度由术前32．8°±5．3°提高至35．7°±5．9°。影像学评估除TLS外均较术前有显著改善，TAS平均提高7．2°±2．8°、TT平均降低4．4°±3．6°、TC平均提高9．8°±3．5°、TLS平均提高0．7°±1．2°。结论合并腓骨截骨的踝上截骨可以显著改善中期内翻型踝关节骨关节炎的临床功能与负重力线；对于术前�Objective To evaluate the functional and radiological outcomes of supramalleolar osteotomy （SMOT） with fib- ular osteotomy for mid-staged varus ankle arthritis. Methods From April 2009 to April 2014, data of twenty-two patients with mid-staged varus ankle osteoarthritis who were treated with SMOT combined with fibular osteotomy and were followed up at least one yearwere retrospectively analyzed. There were 5 males and 17 females with mean age of 52.4 years （range, 37-71 years）. According to modified Takakura ankle osteoarthritis stage, there were 5 cases in stage II, 12 in stage IIIa and 5 stage in IIIh. The American orthopedic foot and ankle society （AOFAS） ankle-hind score, Maryland foot score and Ankle Osteoarthritis Scale （AOS） were used for pre- and postoperative functional evaluation, as well as the range of motion （ROM） of ankle joint on sagittal plane. The tibial anterior surface angle （TAS）, talar tilt （TT）, tibiocrural angle （TC）, and tibial lateral surface angle （TLS） were evaluated pre- and postoperatively. Results The mean follow-up time was 36.6 （range, 17-55） months. Two cases had delay union. One case with postoperative pain and dysfunction was treated by ankle fusion. All of the osteotomy sites reached bony union with a mean time of 3.9 months （range, 3-8 months）. The mean AOFAS score and Maryland score and AOS pain and function scores were improved significantly; the mean AOFAS score increased 31.7±12.5 points, the mean Maryland score increased 22.1±11.5 points, and the mean AOS pain and functional score reduced 16.1±7.4 and 15.6±6.9 respectively. Thirteen cases （62%） had improved on modified Takakura stages, 6 from stage II/III to stage I, 6 from stage III to stage II, and 1 from stage IIIb to stage IIIa. The ROM on sagittal plane increased from 32.8°±5.3° preoperatively to 35.7°±5.9° postoperatively.. For radiological evaluation, all the parameters were improved except TLS; the TAS reached a mean improvement of 7.2°±2.8°, the TF with

关 键 词：踝关节 骨关节炎 腓骨 截骨术 

分 类 号：R687.3[医药卫生—骨科学]