内外踝双截骨行踝关节融合术治疗严重创伤性踝关节炎效果观察  

Internal and external ankle osteotomy for ankle arthrodesis therapeutic effect of severe traumatic arthritis

作　　者：尚林[1] 王翔宇[1] 崔杰[1] 李琦[1] 

机构地区：[1]郑州市骨科医院足踝外科,河南郑州450052

出　　处：《足踝外科电子杂志》2017年第2期20-25,共6页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的观察内外踝双截骨行踝关节融合术治疗严重创伤性踝关节炎的临床效果。方法回顾分析我科2013年7月-2016年6月收治的严重踝关节创伤性关节炎15例的手术资料,其中左踝8例,右踝7例;手术距原发创伤的时间5~10年,平均7.5年;改良Takakura分期均达Ⅳ期。分别于手术前及末次随访时采用美国骨科足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)和视觉疼痛模拟量表(visual analogue scale,VAS)进行评分,并通过影像学检查评价融合效果。结果本组15例手术切口均一期愈合,无术后并发症发生;术后均获随访,随访时间12~20个月,平均16.8个月,X线片均提示关节基本融合,融合时间2.5~4.0个月,平均3.2个月。末次随访时患者均无明显疼痛,未出现内固定失效、钢板螺钉断裂、融合失败等并发症。患者临床症状及功能均显著改善,末次随访时踝-后足AOFAS评分80~97分,平均(85.5±6.7)分;较术前37~48分,平均(51.6±9.3)非常显著提高(P<0.01)。末次随访时VAS评分0~1分,平均(1.2±0.8)分;较术前3~5分,平均(3.5±0.9)非常显著降低(P<0.01)。结论通过内外踝双截骨应用Philos钢板结合空心加压螺钉行踝关节融合术是治疗严重创伤性踝关节炎的有效方法。Objective To observe the clinical effect of ankle arthrodesis with both internal and external malleolus osteotomy in the treatment of severe traumatic ankle arthritis. Methods Review of the operation of severe traumatic arthritis of ankle joint analysis in July 2013 to June 2016 treated 15 cases, including 8 cases of left ankle, right ankle surgery in 7 cases; the time from primary trauma from 5 to 10 years, average 7.5 years;modified Takaknra staging was IV. The American Orthopaedic Foot and Ankle Society before the operation and at the last follow-up respectively （AOFAS） and visual analogue scale （VAS） score, and the imaging fusion effect evaluation. Results This group of 15 cases of surgical incision healed without complications; postoperative follow-up, follow-up time ranged from 12 to 20 months, an average of 16.8 months, X-ray showed joint fusion, fusion time was 2.5-4.0 months, average 3.2 months. At the end of follow-up were not significant pain, no internal fixation failure, plate and screw fracture, such as failure of fusion complications. The clinical symptoms and function of patients were significantly improved at the end of the follow-up AOFAS ankle hindfoot score of 80 to 97,the average （85.5 ± 6.7）; compared with the preoperative 37 to 48 points, the average （51.6 ±9.3） very significant improvement （P〈0.01）. At the last follow-up, the VAS score was 0-1 points, the average （1.2 ± 0.8） score, compared with the preoperative 3-5 points, the average （3.5 ± 0.9） was significantly lower （P〈0.01）. Conclusion The treatment of ankle arthrodesis with Philos plate and hollow compression screw through internal and external malleolus double osteotomy is an effective method for the treatment of severe traumatic ankle arthritis.

关 键 词：踝关节融合术 内外踝截骨 创伤性关节炎 

分 类 号：R687.4[医药卫生—骨科学]