两种髓内钉行胫距跟关节融合术的疗效比较  

Comparison effect of tibiotalocalcaneal arthrodesis using two types of intramedullay nails fixation

作　　者：张凯亭 张宏宁[2] 徐镜程 邹保利 朱永展[2] ZHANG Kai-ting;ZHANG Hong-ning;XU Jing-cheng;ZOU Bao-li;ZHU Yong-zhan(The Eighth Clinical School of Medicine,Guangzhou University of TCM,Guangzhou,Guangdong 510006,China;Dept of Foot and Ankle Surgery,Foshan Hospital of TCM,Foshan,Guangdong 528051,China)

机构地区：[1]广州中医药大学第八临床医学院,广东广州510006 [2]佛山市中医院足踝外科,广东佛山528051

出　　处：《临床骨科杂志》2025年第1期61-65,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较直形髓内钉和单弯髓内钉行胫距跟关节融合术(TTCA)的疗效。方法将49例行TTCA治疗的患者按照髓内钉的不同分为直形组(采用直形髓内钉行TTCA治疗,26例)和单弯组(采用单弯髓内钉行TTCA治疗,23例)。比较两组融合部位骨性愈合时间、关节融合率、术后并发症发生情况、疼痛VAS评分。根据影像学资料评估后足力线异常者(两组各17例)的后足力线并测量内翻角或外翻角。采用AOFAS踝-后足评分评价踝关节功能。结果患者均获得随访,时间12~74(42.1±19.9)个月。融合部位骨性愈合时间、关节融合率、术后并发症发生率两组比较差异均无统计学意义(P>0.05)。疼痛VAS评分、AOFAS踝-后足评分:两组末次随访时均优于术前(P<0.01);末次随访时两组比较差异均无统计学意义(P>0.05)。34例后足力线异常者的后足力线均恢复正常,比较内翻角或外翻角:两组末次随访时均小于术前(P<0.05);末次随访时两组比较差异均无统计学意义(P>0.05)。结论直形髓内钉和单弯髓内钉行TTCA治疗的效果相似,均能有效治疗严重踝关节退变和后足畸形。Objective To compare the efficacy of tibiotalocalcaneal arthrodesis(TTCA)using straight and single-curved intramedullary nails.Methods According to the different types of intramedullary nailing,49 patients undergoing TTCA treatment were divided into two groups:straight group(26 cases were treated by TTCA with straight intramedullary nail)and single-curved group(23 cases were treated by TTCA with single curved intramedullary nail).The bony healing time of fusion site,joint fusion rate,postoperative complications and pain VAS were compared between the two groups.According to the imaging data,the alignment was evaluated in the patients with abnormal hindfoot alignment(17 cases in each group),and the angle of varus or valgus was measured.Ankle function was evaluated by AOFAS ankle-hindfoot score.Results All patients were followed up for 12~74(42.1±19.9)months.There were no statistical differences in bony healing time of fusion site,joint fusion rate and postoperative complications incidence between the two groups(P>0.05).The pain VAS and AOFAS ankle-hindfoot score:At the last follow-up,two groups were better than those before operation(P<0.01),and there was no statistical difference between the two groups at the last follow-up(P>0.05).In 34 patients with abnormal hindfoot alignment,the hindfoot alignment all returned to normal,and the comparison of the varus or valgus angles:The last follow-up of both groups was smaller than that before operation(P<0.05),and there was no statistical difference between the two groups at the last follow-up(P>0.05).Conclusions The curative effect is similar for treatment of TTCA with straight intramedullary nail or single-curved intramedullary nail.Both of them can effectively treat severe ankle joint degeneration and hindfoot deformity.

关 键 词：后足畸形 关节炎 髓内钉 胫距跟关节融合术 

分 类 号：R684.3[医药卫生—骨科学] R687.33[医药卫生—外科学] R687.4[医药卫生—临床医学]