保留或截断腓骨的踝上截骨术治疗内翻型踝关节骨关节炎疗效比较  

Supramalleolar osteotomy treatment of varus ankle osteoarthritis with or without fibular osteotomy

作　　者：赵宏谋[1] 张言[1] 胡东[1] 李毅[1] 梁晓军[1] 刘诚[1] 王军虎[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,西安710054

出　　处：《中国修复重建外科杂志》2017年第3期284-289,共6页Chinese Journal of Reparative and Reconstructive Surgery

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

摘　　要：目的比较踝上截骨术治疗内翻型踝关节骨关节炎时保留腓骨或截断腓骨对疗效的影响。方法回顾分析2009年4月—2014年4月,采用踝上截骨术治疗并随访达1年以上的41例(41足)内翻型踝关节骨关节炎患者临床资料。其中19例术中保留腓骨(A组),22例术中行腓骨截骨(B组)。两组患者性别、年龄、侧别、体质量指数、骨关节炎分期、病因以及术前美国矫形足踝协会(AOFAS)踝与后足评分、踝关节骨关节炎量表(AOS)疼痛及功能评分、踝关节活动度(range of motion,ROM)、胫骨远端关节面角(tibial articular surface angle,TAS)、距骨倾斜角(talar tilt angle,TT)、胫骨踝穴角(tibiocrural angle,TC)、胫骨侧位关节面角(tibial lateral surface angle,TLS)比较,差异均无统计学意义(P>0.05),具有可比性。术后观察截骨愈合情况,比较两组末次随访时临床功能评分以及影像学测量结果。结果两组术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间16~55个月,平均36.6个月。A、B组各1例因疼痛及活动受限,行踝关节融合术,排除末次随访评价。X线片复查示,患者截骨处均获骨性愈合,A组愈合时间(3.6±0.4)个月,B组为(3.9±0.7)个月,比较差异无统计学意义(t=1.61,P=0.12)。末次随访时,两组TAS、TLS、TT、TC比较差异无统计学意义(P>0.05),但B组TT、TC改善程度优于A组(P<0.05)。两组AOFAS评分、AOS疼痛及功能评分、踝关节ROM比较,差异均无统计学意义(P>0.05)。根据改良Takakura分期,A组改善率为55.6%,B组改善率为57.1%,组间比较差异无统计学意义(χ~2=0.01,P=0.92)。结论对于腓骨相对较长或影响术中胫距关节复位者,踝上截骨术中同时行腓骨截骨后TT及TC改善程度优于单纯踝上截骨术。Objective To compare the functional and radiological outcomes ofsupramalleolar osteotomy （SMOT） between with and without fibular osteotomy for varus ankle osteoarthritis. Methods Between April 2009 and April 2014, 41 patients （41 feet） with mid-staged varus ankle osteoarthritis were treated with SMOT. Fibular osteotomy was not performed in 19 cases （group A）, and fibular osteotomy was performed in 22 cases （group B）. There was no significant difference in gender, age, side, body mass index, osteoarthritis stage, pathogeny, American Orthopedic Foot and Ankle Society （AOFAS） ankle-hind score, ankle osteoarthritis scale （AOS） pain and function scores, range of motion （ROM） of the ankle joint, tibial articular surface angle （TAS）, talar tilt angle （TT）, tibiocrural angle （TC）, and tibial lateral surface angle （TLS） between 2 groups （P〉0.05）. The bone union was observed after operation, and functional and radiological outcomes were compared between 2 groups at last follow-up. Results All incisions healed by stage I, and no surgery related complications occurred. The mean follow-up time was 36.6 months （range, 16-55 months）. Pain and limited activity were observed in 1 case of grouos A and B respectively, and ankle arthrodesis was performed. All casesachieved bony union; the bone union time was （3.6±0.4） months in group A and （3.9±0.7） months in group B, showing no significant difference （t=1.61, P=0.12）. At last follow-up, no significant difference was found in TAS, TLS, TT, and TC between groups （P〉O.05）. However, group B was significantly better than group A in improvement of TT and TC （P〈0.05）. The AOFAS ankle-hind score, AOS pain and function scores, ROM of the ankle joint showed no significant difference between groups （P〉0.05）. According to the modified Takakura stage, the improvement rates of groups A and B were 55.6% and 57.1%, respectively; no significant difference was found between 2 groups （t=0.01, P=0.92）. Conclusion

关 键 词：踝关节 骨关节炎 踝上截骨术 腓骨截骨 

分 类 号：R687.31[医药卫生—骨科学]