终末期关节病逆行单平面外翻髓内钉胫距跟融合  

Tbiotalocalcaneal arthrodesis with single plane valgus retrograde intramedullary nail for the end-stage ankle arthropathy

作　　者：张凯亭 邹保利 徐镜程 张宏宁 沈国栋 邹运璇 赖志斌 朱永展 ZHANG Kai-ting;ZOU Bao-li;XU Jing-cheng;ZHANG Hong-ning;SHEN Guo-dong;ZOU Yun-xuan;LAI Zhi-bin;ZHU Yong-zhan(Department of Foot and Ankle Surgery,Foshan Hospital of Traditional Chinese Medicine,Guangzhou University of Chinese Medicine,Foshan,Guangdong 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,广东佛山528000

出　　处：《中国矫形外科杂志》2025年第4期365-368,372,共5页Orthopedic Journal of China

摘　　要：[目的]探讨逆行单平面外翻髓内钉行胫距跟关节融合术治疗终末期踝关节病和后足畸形的临床疗效。[方法]回顾性分析2017年1月—2022年11月本院采用逆行单平面外翻髓内钉行胫距跟关节融合术治疗终末关节病的26例患者的临床资料,评价临床及影像结果。[结果]患者均顺利完成手术,无神经、血管损伤等并发症。随访时间平均(38.5±21.9)个月,与术前相比,术后3个月及末次随访时,VAS评分[(6.1±1.5),(3.7±0.7),(1.6±0.6),P<0.001]显著减少,AOFAS评分[(45.3±4.9),(73.9±6.5),(77.8±5.9),P<0.001]显著增加。影像方面,患者内翻冠状位胫跟角(coronal tibiocalcaneal angle,CTCA)[(14.2±7.8)°,(4.4±1.1)°,(4.7±0.7)°,P=0.014]、外翻CTCA[(10.4±1.1)°,(3.9±0.5)°,(4.5±0.5)°,P=0.002]均显著减小,矢状位胫跟角(sagittal tibiocalcaneal angle,STCA)无显著变化(P>0.05)。至末次随访时,25例患者融合良好,融合时间平均(3.8±0.9)个月,融合率为96.2%。[结论]对于终末期踝关节病和后足畸形患者,采用逆行单平面外翻髓内钉行胫距跟关节融合术具有较好的临床疗效,术中神经、血管损伤风险更小。[Objective]To investigate the clinical outcome of single plane valgus retrograde intramedullary nail used in tibiotalocalcaneal arthrodesis(TTCA)for end-stage ankle arthrosis with hind foot deformity.[Methods]A retrospective study was conducted on 26 patients who underwent TTCA with single plane valgus retrograde intramedullary nail for terminal ankle arthrosis in our hospital from January2017 to November 2022.The clinical and imaging documents were evaluated.[Results]All the patients were operated on successfully without neurovascular injury and other complications,and followed up for an average of(38.5±21.9)months.With time preoperatively,3 monthspostoperatively and at the latest follow-up,the VAS score was significantly decreased[(6.1±1.5),(3.7±0.7),(1.6±0.6),P<0.001],while AOFAS score[(45.3±4.9),(73.9±6.5),(77.8±5.9),P<0.001]increased significantly.As for imaging,the varus coronal tibiocalcaneal angle(CTCA)[(14.2±7.8)°,(4.4±1.1)°,(4.7±0.7)°,P=0.014],and the valgus CTCA[(10.4±1.1)°,(3.9±0.5)°,(4.5±0.5)°,P=0.002]significantly reduced,while the sagittal tibiocalcaneal angle(STCA)had no significant changes(P>0.05).Up to the last follow-up,25 patients had good fusion,with an average fusion time of(3.8±0.9)months,and the fusion rate of 96.2%.[Conclusion]For end-stage ankle arthrosis with hindfoot deformity,single plane valgus retrograde intramedullary nail used in TTCA achieves satisfactory clinical consequence with less risk ofintraoperative neurovascular injury.

关 键 词：踝终末关节病 后足畸形 髓内钉 胫距跟融合 

分 类 号：R681.8[医药卫生—骨科学]