术前合并症对老年晚期骨性踝关节炎关节融合术疗效影响  

Effects of preoperative complications on osteoarthritis of ankle arthroarthritis in elderly patients

作　　者：曲文庆 张俊勇[1] 董圣杰[1] 王振海[1] 王丹[1] 李文亮[1] 郑燕平[2] Qu Wenqing;Zhang Junyong;Dong Shengjie;Wang Zhenhai;Wang Dan;Li Wenliang;Zheng Yanping(Department of Foot and Ankle Surgery, Yantaishan Hospital, Yantai 264008, China;Department of Orthopedics, Qilu Hospital of Shandong University, Jinan 250012, China)

机构地区：[1]烟台市烟台山医院足踝外科,264008 [2]山东大学齐鲁医院骨科,济南250012

出　　处：《中华老年骨科与康复电子杂志》2017年第5期290-295,共6页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：山东省重点研发计划(2016GSF201112);山东省医药卫生科技发展计划项目(2016WS0696);烟台市科技局重点研发计划(2016WS033)

摘　　要：目的观察术前合并症对老年晚期骨性踝关节炎关节融合术疗效的影响。方法回顾性分析烟台市烟台山医院经踝关节融合术治疗的老年晚期骨性踝关节炎患者66例,年龄66~79岁。根据患者是否有术前合并症(主要指慢性内科基础疾病及长期大量吸烟史)分为有术前合并症组(n=50)和无术前合并症组(n=16)。采用美国足踝外科协会踝与后足(AOFAS)评分及疼痛视觉模拟评分(VAS)评价术前及末次随访时足踝部功能,统计患者的满意度、软组织并发症和骨愈合情况。结果所有患者均获得满意随访,随访时间12~49个月,平均(32±7)个月。术前两组患者的AOFAS及VAS评分无统计学差异,末次随访时,无术前合并症组的AOFAS评分高于有术前合并症组,VAS评分低于有术前合并症组,差异有统计学意义(t=4.453,t=1.205,P<0.05)。且组内比较两组患者AOFAS评分和VAS评分均较术前明显改善,差异有统计学意义(t=42.157,t=40.214,t=8.674,t=6.342,P<0.05)。术前合并症组中14例患者术后发生切口并发症,8例患者部分骨性融合但达到负重要求。结论老年晚期踝关节骨性关节炎患者经关节融合术可取得良好疗效,但合并糖尿病和长期大量吸烟的病例术后切口和骨愈合相关并发症发生率较高。Objective To observe the effect of preoperative complications on end-stage ankle arthroarthritis in elderly patients.Methods A retrospective analysis was performed in66geriatric ankle osteoarthritis(end-stage)treated with arthrodesis in Yantaishan Hospital.Age rang were66-79years.Patients were divided into complications group and non-complications group according to preoperative complications(mainly refers to the chronic medical diseases and long-term heavy smoking history).American Orthopaedic Foot and Ankle Society(AOFAS)scores and Visual analogue scale(VAS)were used to evaluate clinical and radiologic results,data were performed before surgery and at the end of follow-up.Patients'satisfaction ratio,soft tissue complications and bone healing time were also analyzed.Results Fifty patients sustained more than one chronic diseases(Diabetes,hypertension,coronary heart disease)and long-term heavy smoking history,ccounting for75.8%.All patients were well followed up for12-49months with an average of32±7months.There was no statistical significance of the AOFAS and VAS between two grops preoperatively.However,at the last follow-up,AOFAS and VASA in the non-complication group were significantly higher than the complication group(t=4.453,t=1.205,P<0.05).Postoperative AOFAS and VASA in two groups were all significantly improved(t=42.157,t=40.214,t=8.674,t=6.342,P<0.05).Conclusions The effect of ankle arthrodesis in end-stage geriatric ankle osteoarthritis was usually good.But the rate of surgical incision infection and bony healing complications were also higher in patients with preoperative complications especially with diabetes mellitus and long-term heavy smoking history.

关 键 词：骨关节炎 踝关节 关节固定术 老年人 术前合并症 

分 类 号：R687.4[医药卫生—骨科学]