关节牵张成形术治疗踝关节创伤性骨关节炎:2年随访研究  

Joint distraction arthroplasty as an alternative treatment for ankle osteoarthritis: a two-year follow-up study

作　　者：肖凯[1] 谢鸣[1] 黄若坤[1] 赵晶晶[1] 潘浩 XIAO Kai XIE Ming HUANG Ruo-kun ZHAO Jing-jing PAN Hao(Pu＇Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Wuhan 430033, Chin)

机构地区：[1]华中科技大学同济医学院附属普爱医院

出　　处：《足踝外科电子杂志》2015年第3期1-5,共5页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的踝关节骨关节炎常由创伤引起，在踝关节骨关节炎的终末期（end-stage ankle arthritis，ESAA）关节功能障碍明显，如何有效治疗中晚期踝关节骨性关节炎，特别是对活动要求高的年轻患者，目前仍然面临挑战。该研究旨在前瞻性分析应用Ilizarov外固定装置进行关节牵张成形治疗踝关节创伤性骨关节炎的可行性。方法选取2011年3月至2013年5月19例中重度踝关节创伤性骨关节炎患者，均通过Ilizarov外固定装置采用关节牵张成形术治疗。关节牵张术后维持3个月，术后允许全负重行走。术前及术后实施标准的临床检查，包括踝关节骨关节炎评分（AOS）、简明健康测量量表（SF-36）、关节活动度（ROM）以及放射学评估踝关节间隙（JSW）改变。结果19例患者中15例患者获得了为期2年的有效随访。15例患者关节活动度ROM以及放射学关节间隙JSW均得到保留。无1例患者施行二期关节融合或者踝关节置换术。踝关节骨关节炎评分AOS、健康量表评分SF-36在2年后最后随访中与治疗前有显著统计学差异。结论联合Ilizarov外固定装置进行关节牵张成形术治疗踝关节创伤性骨关节炎早期临床疗效显著，能够延缓需要进行关节融合或关节置换的时间，具有显著的医疗、社会及经济学意义。Objective Ankle osteoarthritis is more frequently a result of traumatic injury. In its end-stage, there will be an obvious disability. Treatment of severe ankle osteoarthritis remains challenging, especially in young patients. Analyze the feasibility of using Ilizarov apparatus for ankle joint distraction arthroplasty to treat traumatic ankle osteoarthritis. Methods From March 2011 to May 2013,in our department, there were 19 patients with moderate to severe traumatic ankle osteoarthritis treated with Ilizarov apparatus for ankle joint distraction arthroplasty.The distraction was carried out for 3 months, in the duration a full-weight-bearing walking was allowed. The evaluation was done with the Ankle Osteoarthritis Scale （AOS）,Medical Outcomes Study 36-Item Short-Form Health Survey （SF-36）,Range of Motion （ROM）,and Joint Space Width （JSW）. Results All the 19 patients,15 were followed up for a minimum of two years.The final follow-up showed that their ROM and radiographic JSW were preserved well. None of them underwent the arthrodesis or displacement.The AOS and SF-36 scores in the second year of follow-up were significantly improved in comparing with those of before treatment. Conclusion The llizarov joint distraction for arthroplasty is satisfactory for the early stage of moderate or severe ankle osteoarthritis.It delays the need for arthrodesis ordisplacement, being of great medical, social, and economic significance.

关 键 词：关节牵张成形术 踝关节创伤性骨关节炎 踝关节骨关节炎评分 简明健康测量量表 关节活动度 踝关节 间隙 

分 类 号：R687.4[医药卫生—骨科学]