经腓骨截骨入路TTC融合术治疗Kashin-Beck病伴距骨缺血性坏死的疗效分析  

Outcome analysis of TTC arthrodesis with transfibular approach for Kashin-Beck disease with avascular necrosis of talus

作　　者：杨杰[1] 梁晓军[1] 李毅[1] 赵宏谋[1] 王军虎[1] 鹿军 田锋[1] YANG Jie;UANG Xiao-jun;LI Yi;ZHAO Hong-mou;WANG Jun-hu;LU Jun;TIAN Feng(Department of Foot and Ankle Surgery,Xi'an Honghui hospital,Xi'an Jiaotong University,Xi'an,Shaanxi 710054,China)

机构地区：[1]西安交通大学附属红会医院足踝外科诊疗中心

出　　处：《中国骨与关节损伤杂志》2019年第8期818-821,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的研究经腓骨截骨空心钉固定胫距跟关节融合术(TTC融合)治疗Kashin-Beck病伴距骨缺血性坏死的影像学及临床预后疗效,评估其安全性及并发症。方法自2013-03-2016-12诊治Kashin-Beck病伴距骨缺血性坏死16例(A组)纳入研究,均采用经腓骨截骨空心钉固定TTC融合,同时回顾性分析采用钢板螺钉系统或逆行髓内钉系统进行TTC融合治疗Kashin-Beck病伴距骨缺血性坏死13例(B组)的情况。对2组并发症、疼痛VAS评分、AOFAS评分、手术时间、出血量和融合时间等进行比较。结果所有患者均获得随访,平均随访17.3(7~26)个月。在关节融合率方面,A组(16例,100%)较B组(12例,92.3%)高。在手术时间和出血量方面,A组明显优于B组;A组和B组术后VAS评分和AOFAS评分均较术前明显改善,差异有统计学意义(P <0.05)。但2组在关节融合时间、疼痛VAS评分和AOFAS评分改善方面差异无统计学意义(P>0.05)。结论经腓骨截骨空心钉固定TTC融合术治疗Kashin-Beck病伴距骨缺血性坏死的影像学及功能结果好,融合率高,手术时间短,出血量少,并发症少,临床疗效确切。Objective To investigate the effect of radiographic and clinical outcomes of tibiotalocalcaneal arthrodesis (TTC fusion) with transfibular approach for Kashin -Beck disease with talar avascular necrosis,and evaluate the safety and complications.Methods Sixteen patients (group A) with talar avascular necrosis in Kkashin-Beck disease from March 2013 to December 2016 were enrolled in the study.All patients underwent TTC arthrodesis with transfibular approach and fixation with cannulated headless compression screws.Thirteen cases of Kashin-Beck disease with avascular necrosis of talus were treated with TTC arthrodesis with plate and screws system or retrograde intramedullary nail system (group B).The complications,VAS score,time of operation,blood loss and fusion time were compared.Results All the patients were followed up.The average follow-up time was 17.3 months (7-26 months).The rate of TTC arthrodesis in group A (16 cases,100%) was higher than that in group B (12 cases,92.3%).Though the VAS score and AOFAS score in group A were significantly better than those in group B in terms of operation time and blood loss (P <0.05);There was no significant difference between the two groups in joint fusion time and the improvement of VAS score and AOFAS score (P >0.05).Conclusion Transfibular approach and TTC arthrodesis fixed with cannulated headless compression screws can achieve good radiographic and functional outcomes for treating Kashin -Beck disease with avascular necrosis of talus.Compared to the previously described techniques,the fusion rate is higher,the operation time is shorter,the blood loss is less and the complications are less.

关 键 词：Kashin-Beck病 距骨缺血性坏死 经腓骨截骨入路 胫距跟关节融合术 

分 类 号：R687.3[医药卫生—骨科学]