经腓骨入路倒置肱骨近端锁定接骨板结合空心螺钉行踝关节融合术治疗终末期踝关节炎  

End-stage ankle arthrosis treated by ankle arthrodesis with reverse proximal humerus internal locking system plating plus cannulated screwing via the transfibular approach

作　　者：尚林[1] 王翔宇[1] 王爱国[1] 贾光辉[1] 马富强[1] 张小龙 李琦[1] 孙士强[1] 王亚磊[1] Shang Lin;Wang Xiangyu;Wang Aiguo;Jia Guanghui;Ma Fuqiang;Zhang Xiaolong;Li Qi;Sun Shiqiang;Wang Yalei(Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院足踝外科,450052

出　　处：《中华创伤骨科杂志》2020年第7期592-597,共6页Chinese Journal of Orthopaedic Trauma

基　　金：河南省医学科技公关计划联合共建项目(2018020711)。

摘　　要：目的:探讨经腓骨入路倒置肱骨近端锁定接骨板(PHILOS)结合空心螺钉多平面固定行踝关节融合术治疗终末期踝关节炎的疗效。方法:回顾性分析2014年4月至2018年1月郑州市骨科医院足踝外科采用经腓骨入路倒置PHILOS钢板结合空心螺钉多平面固定行踝关节融合术治疗的19例(19踝)终末期踝关节炎的患者资料。男9例,女10例;年龄36~65岁,平均46.7岁;左踝11例,右踝8例;创伤性关节炎9例,骨关节炎6例,距骨缺血性坏死2例,马蹄内翻足2例。所有患者均为Morrey-Wiedeman关节炎影像学分期Ⅲ期。记录术前和末次随访时患者的美国足踝外科协会(AOFAS)的踝-后足评分、视觉模拟评分(VAS)、关节融合情况及并发症发生情况。结果:19例患者术后获18~62个月(平均31.5个月)随访,AOFAS的踝-后足评分为由术前(46.3±2.1)分提高至末次随访时(81.6±0.9)分,VAS由术前(7.1±0.2)分降低至末次随访时(2.0±0.2)分,差异均有统计学意义(P<0.001)。踝关节全部达到骨性融合,融合时间9~14周(平均11.5周)。无一例发生内固定物松动或断裂。末次随访时所有患者均对手术表示满意。1例患者术后出现足跟外侧皮肤感觉减退,口服营养神经药物3个月后恢复。1例患者术后2周拆线时外侧切口出现裂开,经清创后逐渐愈合。末次随访时2例患者出现距下关节退变,1例患者出现距舟关节退变,但都无临床症状。结论:经腓骨入路倒置PHILOS钢板结合空心螺钉多平面固定行踝关节融合术治疗终末期踝关节炎,固定可靠、融合时间短,减轻了疼痛和改善了踝关节功能,是治疗终末期踝关节炎的有效方法。Objective To analyze the therapeutic effect of ankle arthrodesis with reverse proximal humerus internal locking system plating plus cannulated screwing via the transfibular approach in the treatment of end-stage ankle arthrosis.Methods From April 2014 to January 2018,19 patients(19 ankles)with end-stage ankle osteoarthritis were treated at Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital by ankle arthrodesis with reverse PHILOS plating plus cannulated screwing via the transfibular approach for multi-plane fixation.They were 9 men and 10 women,aged from 36 to 65 years(average,46.7 years).The disorder was further diagnosed as traumatic arthritis in 9 cases,as osteoarthritis in 6,as talar necrosis in 2 and as equinovarus in 2,and affected the left ankle in 11 cases and the right in 8.All cases belonged to stageⅢosteoarthritis according to the Morrey-Wiedeman imaging classification.Their American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,visual analogue scale(VAS),joint fusion and complications were observed preoperatively and at the last follow-up.Results All the 19 patients were followed up for 18 to 62 months(average,31.5 months).Their AOFAS scores were improved from preoperative 46.3±2.1 to 81.6±0.9 at the last follow-up,and their VAS was reduced from preoperative 7.1±0.2 to 2.0±0.2 at the last follow-up,showing significant differences(P<0.001).All their ankle joints obtained bony fusion after 9 to 14 weeks(mean,11.5 weeks).No implant loosening or breakage was observed.All the patients were satisfied with their operative results at the last follow-up.Dorsal lateral foot numbness was observed in one patient who became asymptomatic after neurotrophic medication for 3 months.Lateral distal wound dehiscence happened during removal of stitches at 2 weeks after operation in another patient but healed after debridement.The last follow-up found subtalar joint degeneration in 2 cases and talonavicular joint degeneration in one but no clinical symptoms in the 3.Conclusion Ankle

关 键 词：关节融合术 踝 腓骨 骨板 空心螺钉 

分 类 号：R687.4[医药卫生—骨科学]