踝上弧形截骨治疗内翻型踝关节炎的疗效分析  

Supramalleolar dome osteotomy for varus-type ankle arthritis:radiologic and clinical outcomes

作　　者：武勇[1] 赖良鹏[1] 龚晓峰[1] 李莹[1] 王岩[1] 孙宁[1] 李文菁[1] Wu Yong;Lai Liangpeng;Gong Xiaofeng;Li Ying;Wang Yan;Sun Ning;Li Wenjing(Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院足踝外科,100035

出　　处：《中华创伤骨科杂志》2021年第4期284-290,共7页Chinese Journal of Orthopaedic Trauma

基　　金：北京积水潭医院院级科研基金(ZR-201924)。

摘　　要：目的评估踝上弧形截骨治疗内翻型踝关节炎的疗效。方法回顾性研究北京积水潭医院足踝外科2018年6月至2019年12月行踝上弧形截骨治疗的13例内翻型踝关节炎患者资料。其中男5例,女8例;年龄16~65岁,平均47.2岁;采用改良的Takakura分期对关节炎分期:2期3例,3a期4例,3b期6例。比较患者术前和末次随访时的美国足踝外科协会(AOFAS)的踝-后足评分、足部功能指数(FFI)、疼痛视觉模拟评分(VAS)、关节炎Takakura分期、背伸、跖屈角度及整体活动度(ROM)、胫骨远端关节面正位角(TAS)、胫骨远端关节面侧位角(TLS)及距骨倾斜角(TT)。结果所有患者随访12~29个月(平均17.2个月)。末次随访时AOFAS的踝-后足评分[(86.5±8.0)分]、FFI(14.5±1.6)、VAS评分[(1.5±1.0)分]、Takakura分期(2.7±1.3)、ROM(39.4°±8.0°)、TAS(92.4°±6.0°)、TT(3.7°±4.4°)较术前[(68.3±14.4)分、43.7±3.0、(4.2±1.4)分、3.2±0.8、43.3°±7.6°、78.2°±8.3°、7.0°±5.1°]显著改善,背伸角度(10.9°±4.4°)较术前(13.6°±5.1°)显著减小,差异均有统计学意义(P<0.05)。末次随访时跖屈角度(28.5°±5.2°)、TLS(78.1°±5.3°)与术前(29.7°±4.6°、77.8°±4.5°)比较,差异均无统计学意义(P>0.05)。结论踝上弧形截骨治疗内翻型踝关节炎具有良好的早期临床疗效,可显著降低疼痛,纠正畸形,改善关节炎进展和功能,但可能会对背伸功能造成影响。Objective To evaluate the radiologic and clinical outcomes of supramalleolar dome osteotomy in the treatment of varus-type ankle arthritis.Methods From June 2018 to December 2019,13 patients with varus-type ankle arthritis underwent supramalleolar dome osteotomy at Department of Foot and Ankle Surgery,Beijing Jishuitan Hospital.Of them,13(5 males and 8 females)were included in the study.Their average age at surgery was 47.2 years(range,from 16 to 65 years).By the modified Takakura staging for arthritis,3 cases were stage 2,4 cases stage 3a and 6 cases stage 3b.Comparisons were made between preoperation and the last follow-up in ankle-hindfoot score of American Orthopedic Foot and Ankle Society(AOFAS),foot function index(FFI),visual analogue scale(VAS),Takakura staging,dorsal extension,plantar flexion,range of motion(ROM),tibial anterior surface angle(TAS),tibial lateral surface angle(TLS),and talar tilt(TT).Results This cohort were followed up for 12 to 29 months(average,17.2 months).At the last follow-up,AOFAS score(86.5±8.0),FFI(14.5±1.6),VAS score(1.5±1.0),Takakura staging(2.7±1.3),ROM(39.4°±8.0°),TAS(92.4°±6.0°),TT(3.7°±4.4°)were significantly improved than the preoperative values(68.3±14.4,43.7±3.0,4.2±1.4,3.2±0.8,43.3°±7.6°,78.2°±8.3°and 7.0°±5.1°),and dorsal extension(10.9°±4.4°)was significantly smaller than the preoperative value(13.6°±5.1°)(all P<0.05).There were no significant differences between preoperation and the last follow-up in plantar flexion(29.7°±4.6°versus 28.5°±5.2°)or TLS(77.8°±4.5°versus 78.1°±5.3°)(P>0.05).Conclusions Supramalleolar dome osteotomy has shown promising short-term clinical efficacy in the treatment of varus-type ankle arthritis.It can significantly relieve pain,improve function,substantially correct deformity and retard progression of arthritis,but it may affect dorsal extension.

关 键 词：踝关节 关节炎 活动范围 关节 截骨 

分 类 号：R687.4[医药卫生—骨科学]