踝上截骨术与踝关节融合术治疗伴距骨倾斜的Takakura 3A期内翻型踝关节骨关节炎的疗效比较  

Effectiveness comparison of supramalleolar osteotomy and ankle arthrodesis in treatment of inverted ankle osteoarthritis in Takakura 3A stage with talus tilt

作　　者：杨伟强 付炳金[1] 张洋 朱晓东[1] 刘颖[1] 孙广超[1] YANG Weiqiang;FU Bingjin;ZHANG Yang;ZHU Xiaodong;LIU Ying;SUN Guangchao(Department of Foot and Ankle Surgery,Affiliated Hospital of Binzhou Medical University,Binzhou Shandong,256603,P.R.China)

机构地区：[1]滨州医学院附属医院足踝外科,山东滨州256603

出　　处：《中国修复重建外科杂志》2023年第12期1482-1488,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：山东省医药卫生科技发展计划项目(202104070986)。

摘　　要：目的比较踝上截骨术(supramalleolar osteotomy,SMOT)与踝关节融合术(ankle arthrodesis,AA)治疗伴有距骨倾斜的Takakura 3A期内翻型踝关节骨关节炎(osteoarthritis,OA)的临床疗效。方法回顾分析2016年1月—2020年1月收治且符合选择标准的41例伴有距骨倾斜的Takakura 3A期内翻型踝关节OA患者临床资料,根据手术方式分为SMOT组(21例)和AA组(20例)。两组患者性别、年龄、侧别、致伤原因及术前距骨倾斜角(talar tilt angle,TT)、美国矫形足踝协会(AOFAS)踝-后足评分、疼痛视觉模拟评分(VAS)、简明健康调查量表(SF-36)评分、矢状面活动度(range of motion,ROM)等基线资料比较差异均无统计学意义(P>0.05)。记录两组患者手术时间、术中失血量、部分负重时间及并发症发生情况;采用AOFAS踝-后足评分、VAS评分、SF-36评分以及矢状面ROM评价临床疗效;术后复查X线片观察骨愈合情况并记录骨性愈合时间;SMOT组于踝关节负重正侧位X线片上测量胫骨侧位关节面角(tibial lateral surface angle,TLS)、TT、胫骨远端前侧关节面角(tibial articular surface angle,TAS)并与术前比较,同时行Takakura分期评估。结果AA组手术时间、术中失血量均少于SMOT组(P<0.05)。两组患者均获随访,随访时间24~36个月,平均28.9个月。SMOT组和AA组分别有2例和1例发生切口感染,两组均无血管、神经损伤等并发症发生。SMOT组部分负重时间早于AA组(P<0.05),但两组骨性愈合时间差异无统计学意义(P>0.05)。末次随访时,AA组VAS评分和SF-36评分手术前后差值均优于SMOT组,SMOT组矢状面ROM手术前后差值低于AA组,差异均有统计学意义(P<0.05);AA组AOFAS踝-后足评分手术前后差值略高于SMOT组,但差异无统计学意义(P>0.05)。两组上述评分均较术前明显改善(P<0.05);AA组矢状面ROM较术前明显降低(P<0.05),SMOT组与术前比较差异无统计学意义(P>0.05)。SMOT组17例患者(81.0%)影像学分期较术前改善,2�Objective To compare the effectiveness of supramalleolar osteotomy(SMOT)and ankle arthrodesis(AA)in the treatment of inverted ankle osteoarthritis(OA)in Takakura 3A stage with talus tilt.Methods The clinical data of 41 patients with inverted ankle OA in Takakura 3A stage with talus tilt admitted between January 2016 to January 2020 and met the selection criteria were retrospectively analyzed,and they were divided into SMOT group(21 cases)and AA group(20 cases)according to the surgical method.There was no significant difference in baseline data such as gender,age,affected side,cause of injury,and preoperative talar tilt angle(TT),American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,visual analogue scale(VAS)score,short-form 36 health survey scale(SF-36)score,and sagittal range of motion(ROM)between the two groups(P>0.05).The operation time,intraoperative blood loss,partial weight-bearing time,and complications were recorded in the two groups.AOFAS ankle-hindfoot score,VAS score,SF-36 score,and sagittal ROM were used to evaluate the effectiveness.Bone healing was observed and the time of bony healing was recorded.In the SMOT group,the tibial lateral surface angle(TLS),TT,and the tibial articular surface angle(TAS)were measured on ankle joint weight-bearing anteroposterior and lateral X-ray films and compared with those before operation.And Takakura staging assessment was also performed.Results The operation time and intraoperative blood loss in AA group were significantly less than those in SMOT group(P<0.05).Patients in both groups were followed up 24-36 months,with an average of 28.9 months.Incision infection occurred in 2 patients in SMOT group and 1 patient in AA group,respectively,and no vascular or nerve injury occurred in both groups.The partial weight-bearing time of SMOT group was significantly less than that of AA group(P<0.05),but there was no significant difference in bony healing time between the two groups(P>0.05).At last follow-up,the difference of VAS score and SF-36 score before a

关 键 词：踝上截骨术 踝关节融合术 骨关节炎 Takakura分期 距骨倾斜角 

分 类 号：R687.3[医药卫生—骨科学]