应用腓骨瓣支撑辅助结合空心螺钉行胫距跟融合术疗效观察  

Analysis of the effect of tibiotalocalcaneal arthrodesis with fibular strut combined with hollow screw

作　　者：于鹤[1] 宋秀锋[1] 郑加法[1] 李宏志[1] 周锦明[1] 王子栋[1] YU He;SONG Xiufeng;ZHENG Jiafa;LI Hongzhi;ZHOU Jinming;WANG Zidong(Department of Ankle Surgery,Dalian Second People's Hospital,Liaoning Dalian 116000,China)

机构地区：[1]大连市第二人民医院足踝外科,辽宁大连116000

出　　处：《足踝外科电子杂志》2018年第1期19-22,共4页Electronic Journal of Foot and Ankle Surgery

摘　　要：目的观察腓骨瓣支撑辅助结合空心螺钉行胫距跟融合术的临床疗效。方法 2012年3月至2016年3月应用腓骨瓣支撑辅助结合空心螺钉行胫距跟融合术治疗胫距跟关节病变39例,获得随访32例。分别于术后1个月、3个月、6个月及12个月观察患肢疼痛、并发症发生情况,行影像学检查确认胫距跟关节融合及内固定情况,采用美国足踝外科协会(AOFAS)踝-后足评分标准评估功能改善情况。结果获随访32例,平均随访时间(39±14)个月。1例内翻35°的患者内侧辅助切口愈合不良,对症处理1个月后切口愈合良好;其余患者术后切口愈合良好,无感染及坏死。术后3个月随访,患肢均无明显疼痛,X线检查显示手术关节基本融合、内固定无松动断裂;术后12个月患肢均无疼痛,影像学检查显示手术关节均已融合。术前AOFAS踝-后足评分为(37.2±13.8)分,术后评分为(75.8±8.8)分,差异具有统计学意义(P<0.05)。结论应用腓骨瓣支撑辅助结合空心螺钉行胫距跟关节融合术具有优良的融合率、可矫正畸形并改善功能,是治疗严重胫距跟关节病变的有效方法。Objective To observe the clinical effect of tibiotalocalcaneal arthrodesis with fibular strut combined with hollow screw.Methods A group of 39 patients with tibiotalocalcaneal joint lesions who received the operation from March 2012 to March 2016 was retrospectively analyzed,32 patients were followed up.In the 1,3,6 and 12 months after the operation,the pain and complications were oberved.Confirmation of tibiotalocalcaneal arthrodesis and internal fixation by imaging examination.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hind-foot score was used to evaluate the improvement of ankle joint function.Results Thirtytwo patients were followed up,with an average duration of 39±14 months.The medial accessory incision of 1 patient with 35 degrees of varus was not healed,and the incision healed well after 1 month of symptomatic treatment.The remaining patients healed well after operation without infection and necrosis.After 3 months of follow-up,there was no obvious pain in the affected limbs.X-ray examination showed the basic fusion of the surgical joint,Internal fixation without loosening fracture.There was no pain in the limbs at 12 months after the operation,and the imageology showed that all the affected limbs had been fused.The preoperative AOFAS score was(37.2±13.8),the postoperative AOFAS score was(75.8±8.8).The difference was statistically significant(P<0.05).Conclusion The fusion rate of tibiotalocalcaneal arthrodesis with fibular strut combined with hollow screw was good.It can effectively correct malformation and improve function.It was an effective method for the treatment of severe tibiotalocalcaneal joint lesions.

关 键 词：胫距跟关节融合 腓骨截骨 空心螺钉 

分 类 号：R687.3[医药卫生—骨科学]