带血供腓骨瓣与空心螺钉胫距跟融合治疗终末期踝关节炎  

Tibiotalocalcaneal arthrodesis with blood supplied fibular flap combined with hollow screw in the treatment of end-stage ankle osteoarthritis

作　　者：于鹤[1] 郑加法[1] 宋秀锋[1] 关盛溢[1] Yu He;Zheng Jiafa;Song Xiufeng;Guan Shengyi(Department of Ankle Surgery,Dalian No.2 People’s Hospital,Dalian 116000,Liaoning Province,China)

机构地区：[1]大连市第二人民医院足踝外科,辽宁省大连市116000

出　　处：《中国组织工程研究》2023年第4期588-593,共6页Chinese Journal of Tissue Engineering Research

基　　金：大连市科技创新基金(2021JJ13SN54),项目负责人:于鹤。

摘　　要：背景:既往研究报道腓骨瓣支撑结合空心螺钉行胫距跟融合治疗踝关节骨性关节炎有确切效果,但所用腓骨瓣未带血供,在一定程度上影响局部血运恢复。此次研究利用腓骨远端良好血运,对腓骨瓣支撑结合空心螺钉胫距跟融合进行改良,探讨改良术式治疗踝关节骨性关节炎的临床效果。目的:探讨经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗终末期踝关节骨性关节炎的临床疗效,以及对患肢生物力学的影响。方法:回顾分析2018年1月至2020年10月大连市第二人民医院收治的30例终末期踝关节骨性关节炎患者,均择期实施经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗。术后接受12个月随访,观察术后腓骨远端局部血运状况及切口Ⅰ期愈合情况;术后复查踝关节CT,评估骨愈合时间;应用步态分析仪及足底压力测量系统评估术后恢复情况,掌握术后并发症。结果与结论:①患者术后均接受12个月随访,无失访病例;术后多普勒血管探测仪及下肢血管CT血管造影复查显示,患肢血管蒂和腓后动脉穿支及伴行静脉吻合,局部血运良好,切口均为Ⅰ期愈合;②术后复查踝关节CT,融合处骨性愈合时间为8-13周,平均(10.70±2.13)周;③术后3个月患者的步长、步速及步频均较术前显著提升,差异有显著性意义(P<0.05);④通过足底压力测量系统测定分析,术后6个月患者自然行走中,患侧足底第2-4跖骨区、中足、足跟内侧、足跟外侧、全足底的压力值均低于术前,差异有显著性意义(P<0.05);⑤术后随访,1例患者出现腓肠神经损伤症状,在对症治疗后消失;⑥患者踝关节功能恢复优良率为100%;⑦提示经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗终末期踝关节骨性关节炎,可有效改善局部血运,提高融合效果,促进患肢踝关节功能恢复,有重要的临床意义。BACKGROUND:Previous studies have reported that tibiotalocalcaneal arthrodesis via fibular flap support combined with hollow screw has a definite effect in the treatment of ankle osteoarthritis,but the fibular flap does not have blood supply,which affects the recovery of local blood circulation to a certain extent.In this study,the tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screw was improved by using the good blood supply of the distal fibula,and the clinical effect of the improved operation in the treatment of ankle osteoarthritis was discussed.OBJECTIVE:To investigate the biomechanical effects on affected limbs and the clinical effect of tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screw for ankle osteoarthritis.METHODS:From January 2018 to October 2020,30 patients with severe ankle osteoarthritis in Dalian No.2 People’s Hospital were included in this study,and all patients underwent tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screws.After 12 months of follow-up,local blood circulation of distal fibula and the stage I healing of the incision were observed,and the ankle CT was reviewed postoperatively to evaluate the time of bone healing.The postoperative recovery was evaluated by gait analyzer and plantar pressure measurement system and the postoperative complications were mastered.RESULTS AND CONCLUSION:(1)All patients were followed up for 12 months after operation,and no case of loss to follow-up was found.Postoperative Doppler angiography showed that the vascular pedicle of the affected limb and perforating branches of the posterior peroneal artery were accompanied by venous anastomosis;local blood circulation was good;and the incisions were all in stage I healing.(2)After surgery,the ankle CT examination showed that the bone healing time at the fusion site was 8-13 weeks,with a mean of(10.70±2.13)weeks.(3)At 3 months after surg

关 键 词：带血供腓骨瓣 空心螺钉 胫距跟融合 踝关节 骨性关节炎 局部血运 骨愈合 足底压力 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687