两种胫距跟关节融合技术的临床疗效比较  

Comparison of clinical outcomes of tibiotalocalcaneal arthrodesis by two surgical techniques

作　　者：亢哲 商炜 付攀峰 邓宇[1] 屈文强 祝少博[1] KANG Zhe;SHANG Wei;FU Pan-feng;DENG Yu;QU Wen-qiang;ZHU Shao-bo(Orthopedic Center,Zhongnan Hospital,Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院骨科中心,湖北武汉430071

出　　处：《中国矫形外科杂志》2021年第11期985-989,共5页Orthopedic Journal of China

摘　　要：[目的]比较经腓骨入路PHILOS钢板联合无头加压螺钉与交叉螺钉技术在胫距跟关节融合中的临床疗效。[方法]回顾性分析2015年—2018年本院收治的49例(51例足)接受胫距跟关节融合的患者。其中,22例(24例足)采用PHILOS钢板联合无头加压螺钉固定,27例(27例足)采用交叉螺钉固定。比较两组患者围手术期、随访及影像学资料。[结果]所有患者均顺利完成手术,两组患者手术时间、术中出血量、住院时间、并发症发生率和骨移植材料的使用方面差异无统计学意义(P>0.05)。所有患者均随访12个月以上,两组末次随访时的AOFAS和VAS评分均较术前显著改善(P<0.05),两组间术前AOFAS评分、术前及末次随访时VAS评分和患者主观满意度差异均无统计学意义(P>0.05),但是,钢板组患者末次随访AOFAS评分及临床结果评级显著优于螺钉组(P<0.05)。影像方面,至末次随访,钢板组患者全部融合,螺钉组4例未融合,钢板组影像关节融合情况显著优于螺钉组(P<0.05)。[结论]相较于交叉螺钉,PHILOS钢板联合无头加压螺钉技术在术后AOFAS评分、临床结果评级和关节融合情况取得了更好的结果,是实现胫距跟关节融合的有效技术手段。[Objective]To compare the clinical efficacy of tibiotalocalcaneal(TTC)arthrodesis through transfibular approach with fixation of PHILOS plate combined with headless compression screw versus cross screw.[Methods]A retrospective study was conducted on 49 patients(51 feet)who underwent TTC fusion from 2015 to 2018 in our hospital.Among them,22 patients(24 feet)had TTC fixed with PHILOS steel plate combined with headless compression screws,while the remaining 27 patients(27 feet)had TTC fixed with cross screws.The two groups were compared regarding documents of perioperative period,follow-up and images.[Results]All patients had operation completed successfully with no statistically significant differences between the two groups in terms of operation time,intraoperative blood loss,hospital stay,complication rate and whether bone grafting used(P>0.05).All patients were followed up for more than 12 months.The AOFAS and VAS scores at the latest follow-up in the two groups were significantly improved compared with those before the operation(P<0.05).Although there were no statistically significant differences in preoperative AOFAS score,the VAS score before operation and at the latest follow-up,as well as patient.s subjective satisfaction between the two groups(P>0.05),the plate group proved significantly superior to the screw group in AOFAS score and clinical outcome grade at the latest follow-up(P<0.05).With respect to imaging evaluation,all patients in the plate group achieved bony fusion,whereas 4 patients in the screw group were not fused at the latest follow-up.[Conclusion]Compared with the cross screw,the PHILOS plate combined with the headless compression screw does achieve better clinical results in term of AOFAS score and clinical result grade,is an effective technical way to achieve tibiotalocalcaneal arthrodesis.

关 键 词：胫距跟关节融合 肱骨近端锁定钢板 螺钉 

分 类 号：R687[医药卫生—骨科学]