踝关节脱位暴露与传统后外侧入路暴露在治疗复杂后踝畸形愈合中的应用比较  

Comparison of ankle dislocation exposure versus traditional posterolateral approach exposure in the treatment of complex posterior ankle malunion

作　　者：朱永展 白文博 邹保利 张宏宁 徐志强[2] 沈国栋 Zhu Yongzhan;Bai Wenbo;Zou Baoli;Zhang Hongning;Xu Zhiqiang;Shen Guodong(Department of Foot and Ankle Orthopedics,Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine,Foshan 528000,China;Studio of Xu Zhiqiang A Famous Doctor of Traditional Chinese Medicine,Foshan Traditional Chinese Medicine Hospital,Foshan 528000,China)

机构地区：[1]广州中医药大学附属佛山中医院足踝外科,佛山528000 [2]广东省佛山市中医院徐志强名中医工作室,佛山528000

出　　处：《中华创伤骨科杂志》2025年第1期32-38,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨踝关节脱位暴露畸形与传统后外侧入路暴露畸形在治疗复杂后踝畸形愈合中的应用疗效。方法回顾性分析2015年5月至2023年6月广州中医药大学附属佛山中医院足踝外科收治的50例后踝畸形愈合患者。男18例,女32例;年龄(46.2±12.0)岁;受伤至手术时间7.0(4.0,12.2)个月。根据手术暴露方式不同分为脱位法组(22例,踝关节脱位法暴露畸形愈合后复位固定)和后外侧组(28例,传统后外侧入路暴露畸形后复位固定)。比较两组患者的手术时间、踝关节炎分级、并发症的发生率,术前与末次随访时的胫骨远端关节面角和关节面台阶、疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-后足评分。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获(39.4±17.9)个月随访。脱位法组患者的手术时间[(95.8±9.9)min]显著短于后外侧组[(121.9±14.3)min],末次随访时胫骨远端关节面台阶[0.3(0.0,0.9)mm]显著低于后外侧组[1.0(0.3,1.1)mm],末次随访时踝关节炎分级较后外侧组患者减轻,差异均有统计学意义(P<0.05)。两组患者间的末次随访时胫骨远端关节面角、疼痛VAS评分、AOFAS踝-后足评分、并发症发生率比较差异均无统计学意义(P>0.05)。结论踝关节脱位暴露畸形与传统后外侧入路暴露畸形复位固定治疗复杂后踝畸形愈合均可以获得良好的疗效,前者更有利于恢复胫骨远端关节面的解剖一致性。ObjectiveTo compare the clinical and radiological outcomes between the ankle dislocation exposure versus the traditional posterolateral approach exposure in the treatment of complex posterior ankle malunion.MethodsThis retrospective study analyzed the 50 patients(50 feet)with posterior ankle malunion who had been treated at Department of Foot and Ankle Orthopedics,Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from May 2015 to June 2023.This cohort included 18 males and 32 females,with an age of(46.2±12.0)years.The duration from injury to surgery averaged 7.0(4.0,12.2)months.The patients were divided into 2 groups based on the surgical exposure methods:an ankle dislocation group(22 cases)in which the posterior ankle malunion was exposed by ankle dislocation before reduction and fixation,and a traditional posterolateral approach group(28 cases)in which the posterior ankle malunion was exposed by the traditional posterolateral approach before reduction and fixation.Evaluation indices included operative time,ankle arthritis grading,incidence of complications,as well as pre-operative and last follow-up recordings of distal tibial articular angle and joint step-off,visual analogue scale(VAS)pain score,and ankle-hindfoot score of American Orthopaedic Foot and Ankle society(AOFAS).ResultsThere was no significant difference in the baseline data between the 2 groups,indicating comparability(P>0.05).The average follow-up was(39.4±17.9)months.The operative time in the dislocation group[(95.8±9.9)min]was significantly shorter than that in the posterolateral approach group[(121.9±14.3)min](P<0.05).The step-off on the distal tibial articular surface at the last follow-up in the dislocation group[0.3(0.0,0.9)mm]was significantly lower than that in the posterolateral approach group[1.0(0.3,1.1)mm](P<0.05).The grading of ankle arthritis was significantly worse in the posterolateral approach group than that in the dislocation group(P<0.05).There were no differences in dis

关 键 词：踝关节 骨折愈合 外科手术 选择性 踝关节脱位法 

分 类 号：R68[医药卫生—骨科学]