经腓骨钢板是否结合空心钉踝关节融合比较  

Comparison of ankle arthrodesis using reverse PHILOS plate with or without cannulated screws through transfibular approach for end-stage ankle arthropathies

作　　者：尚林[1] 贾光辉[1] 王亚磊[1] 马富强[1] 李琦[1] 张小龙 孙士强[1] 王翔宇[1] 王爱国[1] SHANG Lin;JIA Guang-hui;WANG Ya-lei;MA Fu-qiang;LI Qi;ZHANG Xiao-long;SUN Shi-qiang;WANG Xiang-yu;WANG Ai-guo(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,河南郑州450052

出　　处：《中国矫形外科杂志》2021年第23期2130-2134,共5页Orthopedic Journal of China

基　　金：河南省医学科技公关计划联合共建项目(编号:2018020711)。

摘　　要：[目的]对比分析经腓骨PHILOS钢板是否结合空心钉行踝关节融合术的疗效。[方法]2014年1月-2019年5月,60例终末期踝关节炎患者纳人本研究,并随机分为两组。其中,30例采用单纯PHILOS钢板逆向固定踝关节融合(单钢板组),30例采用钢板联合空心钉固定踝关节融合(联合组)。比较两组围手术期情况、随访结果及影像学资料。[结果]两组患者均顺利完成手术,两组手术时间、切口长度、术中失血量、术后引流量及住院时间差异无统计学意义(P>0.05),联合组术中透视次数显著多于单钢板组(P<0.05)。联合组恢复术后下地行走时间和完全负重活动时间均显著早于单钢板组(P<0.05)。末次随访时两组AOFAS后足-踝关节评分和VAS评分均较术前明显改善(P<0.05),但相应时间点两组间上述评分的差异无统计学意义(P>0.05)。影像方面,末次随访时两组冠状面和矢状面胫-跟角均较术前明显改善(P<0.05),但相应时间点两组间上述影像指标的差异均无统计学意义(P>0.05)。联合组达到影像骨性愈合时间显著早于单钢板组(P<0.05)。[结论]相较于单纯钢板固定,PHILOS钢板结合空心钉固定踝关节融合的稳定性更好,更有利于踝关节融合。[Objective]To compare the clinical outcomes of ankle arthrodesis using reverse proximal humeral internal locked system(PHILOS)plate with or without cannulated screws through transfibular approach for end-stage ankle arthropathies.[Methods]From January 2014 to May 2019,a total of 60 patients with unilateral end-stage ankle arthropathies were enrolled in this study and divided randomly into two groups.Of them,30 patients underwent ankle arthrodesis with PHILOS plate fixation only(the plate group),while the remaining 30 patients received ankle arthrodesis by PHILOS plate combined with cannulated screws fixation(the combined group).The two groups were compared regarding to perioperative conditions,follow-up results and imaging data.[Results]All patients in both groups had surgical procedures performed smoothly,with no statistically significant differences in terms of operative time,intraoperative blood loss,postoperative drainage and hospital stay between the two groups(P>0.05),despite of the fact that the combined group had significantly more frequency of fluoroscopy intraoperatively than the plate group(P<0.05).The combined group resumed walking and full weight bearing activity significantly earlier than the plate group(P<0.05).The VAS and AOFAS scores significantly improved postoperatively in both groups compared with those before operation(P<0.05),but no statistically significant differences in abovementioned scores were noted between the two groups at any matching time point(P>0.05).With respect to radiographic evaluation,the tibiocalcaneal angles measured by both sagittal plane and coronal plane significantly improved postoperatively compared with those preoperatively in both groups(P<0.05),which proved not significantly different between the two groups at any corresponding time point(P>0.05).However,the combined group presented bony fusion on radiographic images significantly earlier than the plate group(P<0.05).[Conclusion]The plate combined with cannulated screws has a benefit of improved stability,which is

关 键 词：终末期踝关节病 踝关节融合术 经腓骨入路 钢板 空心钉 

分 类 号：R687[医药卫生—骨科学]