外固定架融合和加压空心钉融合治疗终末期踝关节骨关节炎的临床疗效对比  

Comparison of clinical effect between external fixator fusion and pressurized hollow screw fusion in the treatment of end-stage ankle osteoarthritis

作　　者：王立伟 曹光磊[1] 刘利民[1] 冯明利[1] 沈惠良[1] Wang Liwei;Cao Guanglei;Liu Limin;Feng Mingli;Shen Huiliang(Department of Orthopedics,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院骨科,北京100053

出　　处：《北京医学》2020年第3期197-200,共4页Beijing Medical Journal

摘　　要：目的评价外固定架融合和加压空心钉融合治疗终末期踝关节骨关节炎的临床疗效。方法选取首都医科大学宣武医院2016年7月至2018年9月收治的62例终末期踝关节骨关节炎患者,采用随机数表法分为两组,分别应用踝关节融合外固定架固定(观察组)和踝关节融合空心钉固定(对照组)。观察比较两组患者术前、术后美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足功能评分、生活质量改善情况(SF-36生活质量量表)、视觉模拟评分(visual analogue score,VAS),以及早期临床疗效和并发症情况。结果观察组34例,对照组28例,所有患者随访时间为6~34个月,平均(18±5)个月。两组患者术后AOFAS踝-后足评分、SF-36、VAS较术前均明显改善,差异有统计学意义(P<0.05)。观察组和对照组的术后AOFAS评分、VAS差异无统计学意义,但前者SF-36评分显著优于对照组(P=0.01)。观察组踝关节均达骨性融合,出现针道红肿2例,换药后愈合;自身免疫性皮炎1例,经皮肤科处理后好转;并发症发生率为8.8%。对照组融合失败1例,其他病例获得骨性融合,伤口愈合不良2例,1例换药后好转,1例再次缝合处理后愈合;并发症发生率为10.7%。结论踝关节融合外固定架治疗终末期踝关节骨关节炎可获得满意疗效,能更快地改善患者的生活质量,部分负重时间更短。Objective To analyze and compare the clinical effect of external fixator fusion and pressurized hollow screw fusion in the treatment of end-stage ankle osteoarthritis.Methods A total of 62 patients with end-stage ankle arthritis admitted to Xuanwu Hospital from July 2016 to September 2018 were selected.The patients were divided into two groups according to different treatment methods by using the random number table.Ankle fusion with external fixator fixation(observation group)and with hollow screw fixation(control group)were applied respectively.American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,visual analogue score(VAS),improvement in quality of life(SF-36 quality of life scale)and complications were compared.Results There were 34 cases in the observation group and 28 cases in the control group.All patients were followed up for 6 to 34 months,with an average of(18±5)months.AOFAS,SF-36,VAS of postoperation improved greatly than preoperaion in both groups(P<0.05).There were no significant differences of postoperative AOFAS and VAS between the two groups,but the score of SF-36 in the observation group was significantly better than that of the control group(P=0.01).In the observation group,the ankle joints were bone fused,and there were two cases of needle redness and swelling,which healed after dressing change;one case of autoimmune dermatitis was cured by dermatology;the complication rate was 8.8%.All ankle joints in the observation group obtained bone fusion.In the control group,one patient failed fusion,while other patients obtained bone fusion,two patients had poor wound healing,one improved after dressing change,and the other one healed after resuture;the complication rate was 10.7%.There was no significant difference in complication rate between the two groups(P>0.05).Conclusions Ankle fusion with external fixator fixation can achieve satisfactory results in the treatment of end-stage ankle osteoarthritis,improve the life quality,and partial weight-bearing time is shorter.

关 键 词：踝关节 骨关节炎 外固定架 空心钉 融合术 

分 类 号：R687.4[医药卫生—骨科学]