后正中经跟腱入路结合锁定接骨板行胫距跟关节融合术的临床应用  

Application of posterior trans-Achilles tendon approach in tibiotalocalcaneal arthrodesis with locking plate

作　　者：鹿军[1] 温晓东[1] 梁晓军[1] 赵宏谋[1] 李毅[1] 王军虎[1] 马强[1] 雷军 LU Jun;WEN Xiaodong;LIANG Xiaojun;ZHAO Hongmou;LI Yi;WANG Junhu;MA Qiang;LEI Jun(Department of Foot and Ankle Surgery,Honghui Hospital,Xi＇an Jiao Tong University,Xi＇an 710054;Department of Orthopedics,Gaoling District Hospital,Xi＇an 710200,China)

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 [2]西安市高陵区医院骨科,西安710200

出　　处：《中华骨与关节外科杂志》2018年第8期574-577,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:关节融合术是治疗终末期关节炎的金标准,对于胫距跟关节融合术有多种入路及内固定方式,后正中经跟腱入路结合锁定接骨板行胫距跟关节融合术的报道鲜见。目的:评价后正中经跟腱入路结合锁定接骨板行胫距跟关节融合术的临床效果。方法:2013年1月到2014年6月采用后正中经跟腱入路结合锁定接骨板行胫距跟关节融合术治疗终末期关节炎患者15例,男8例,女7例;年龄42~68岁,平均(52.1±7.4)岁。术后定期随访复查X线片及CT以明确骨愈合情况,采用VAS评分评估患者疼痛,美国骨科足踝外科(AOFAS)踝与后足评分及健康量表SF-36评分评估恢复效果,并记录相关并发症。结果:15例均获得随访14~30个月,平均(23.4±2.3)个月。复查X线片示术后平均12.4周融合部位骨性愈合(10~15周)。末次随访时,AOFAS评分及SF-36评分均较术前明显改善,疼痛症状明显缓解。1例延迟愈合,1例出现不愈合行翻修手术。结论:后正中经跟腱入路结合锁定接骨板行胫距跟关节融合术安全、有效,在改善患者功能的同时可有效降低并发症发生率。Background： Tibiotalocalcaneal（TTC） fusion is the golden standard for end-staged arthritis. There are varied approaches and implants for TTC arthrodesis, but few studies reported TTC fusion with posterior trans-Achilles tendon approach and locking plate. Objective： To evaluate clinical outcomes of the TTC arthrodesis with locking plates through posterior approach. Methods： From January 2013 to June 2014, 15 patients with end-staged arthritis underwent TTC arthrodesis through a direct posterior approach. There were 8 men and 7 women with a mean age of（52.1±7.4） years old（range, 42-68 years）. Routine X-rays were taken during the follow-up for the confirmation of bone healing. The outcomes were assessed by a combination of pre-and post-operative clinical examinations, including AOFAS hind foot score, VAS score and SF-36 score. The complications were also recorded. Results： The mean duration of follow-up was（23.4±2.3） months（range, 14-30 months） in the 15 patients. X-ray demonstrated bone healing in 12.4 weeks（10-15 weeks） post-operatively in average.The AOFAS hind foot and ankle score and SF-36 score were improved and the pain was relieved significantly at the final follow-up. One case encountered delayed union and another suffered from nonunion and underwent revision surgery. Conclusions： Posterior trans-Achilles tendon approach is a safe and effective choice for TTC arthrodesis with locking plate in the treatment of end-staged arthritis. It can significantly improve functions and reduce the incidence of complications.

关 键 词：胫距跟融合 后正中入路 锁定接骨板 

分 类 号：R687.3[医药卫生—骨科学]