逆行髓内钉胫距跟关节融合术治疗终末期关节病  

Tibiotalocalcaneal arthrodesis by straight retrograde intramedullary nail for end-stage ankle arthropathy

作　　者：刘培珑 梁景棋 张言[1] 温晓东 梁晓军[1] 赵宏谋[1] LIU Pei-long;LIANG Jing-qi;ZHANG Yan;WEN Xiao-dong;LIANG Xiao-jun;ZHAO Hong-mou(Department of Foot and Ankle Surgery,Honghui Hospi-tal,Xi'an Jiaotong University,Xi'an710054,China)

机构地区：[1]西安交通大学附属红会医院足踝外科,陕西西安710054

出　　处：《中国矫形外科杂志》2021年第17期1593-1596,共4页Orthopedic Journal of China

摘　　要：[目的]介绍使用逆行髓内钉行胫距跟关节融合术治疗终末期关节病的技术及初步疗效。[方法]2016年6月-2019年7月对16例终末期关节病的患者使用逆行髓内钉行胫距跟关节融合术。手术采用前侧入路或外侧入路,将患者胫距关节及距下关节软骨及部分软骨下骨彻底清除,用克氏针在软骨下骨钻孔,并临时固定,以维持恰当的后足力线,然后将腓骨自体骨粒植入骨间隙,自足底逆向置入交锁髓内钉固定。[结果]16例患者均顺利完成手术,无严重并发症。随访时间13~50个月,平均(31.40±9.20)个月。AOFAS踝-后足评分由术前(30.20±14.60)分,显著增加至末次随访时(71.30±23.70)分(P<0.05);VAS评分由术前(7.40±2.20)分显著减少至末次随访时(1.60±0.50)分(P<0.05)。影像方面,所有患者均获得骨性融合,平均融合时间(3.70±2.30)个月,融合率为100%。末次随访时,所有患者后足力线良好。[结论]使用直形逆行髓内钉行TTC融合术可有效治疗终末期踝关节病合并后足畸形。[Objective] To introduce the surgical technique and preliminary outcomes of retrograde intramedullary nailing for tibiotalocalcaneal(TTC) arthrodesis for end-stage ankle arthropathy. [Methods] From June 2016 to July 2019, 16 patients with end-stage ankle arthropathy underwent tibiotalocalcaneal arthrodesis with retrograde intramedullary nail. After the remained articular cartilage and subchondral bone of the tibiotalar joint and subtalar joint were removed through the anterior or lateral approach, Kirschner wires was inserted for temporary fixation to maintain proper hindfoot alignment, and then bone autografts of the fibula were inserted into the bone gap and a interlocking intramedullary nail was inserted retrogradely from the foot bottom for fixation. [Results] All the 16 patients were successfully operated on without serious complications, and followed up for 13~50 months with a mean of(31.40±9.20) months. The AOFAS score significantly increased from(30.20±14.60) preoperatively to(71.30±23.70) at the latest follow-up(P<0.001), whereas the VAS score significantly decreased from(7.40±2.20) before operation to(1.60±0.50) at the latest follow-up(P<0.001). With respect of radiographic assessment, all the patients got tibiotalocalcaneal bony fusion in an average of(3.70±2.30) months with fusion rate of 100%. By the time of latest follow-up,all the patients remained proper hindfoot alignment. [Conclusion] This TTC fusion with straight retrograde intramedullary nail is effective for the treatment of end-stage ankle arthropathy accompanied with hindfoot deformities.

关 键 词：踝关节炎 距骨坏死 夏科氏关节病 胫距跟融合术 逆行髓内钉 

分 类 号：R687[医药卫生—骨科学]