逆行带锁髓内针联合胫骨下段滑槽植骨融合术治疗终末期踝关节炎

摘要

目的:探讨运用逆行带锁髓内针联合改良前路胫骨下段滑槽植骨融合术治疗终末期踝关节炎的临床疗效.方法:自2014年11月至2016年4月,采用逆行带锁髓内针联合改良前路胫骨下段滑槽植骨融合术治疗22例保守治疗无效的终末期踝关节炎患者,其中男9例,女13例;年龄30～65岁,平均48.5岁.7例有明显足内翻畸形,15例外观大致正常.观察患者的手术时间、术中出血量、骨折愈合时间及并发症情况,并于术前及术后9个月采用美国足踝外科协会(AOFAS)踝-后足评分、视觉模拟评分(VAS)对其足踝关节功能和疼痛情况进行评价.结果:22例患者均获得随访,时间12～24个月,平均18.6个月.伤口均I级愈合,未出现伤口坏死或骨折不愈合,无早期并发症发生.本组患者手术时间80～120 min,平均90 min;术中出血量15～50 ml,平均30 ml;骨性愈合时间10～18周,平均14周.术后9个月随访时AOFAS评分(88.00±3.45)与术前(54.82±2.98)比较,差异有统计学意义(P＜0.01);其中优8例,良12例,可2例.术后9个月VAS评分(3.96±1.27)与术前(9.37±0.55)比较,差异有统计学意义(P＜0.05).结论:逆行带锁髓内针联合改良前路胫骨下段滑槽植骨融合术治疗终末期踝关节炎,稳定可靠、创伤小、出血少、关节都得到融合,术后功能恢复良好,可明显缓解疼痛临床疗效显著.%Objective:To explore clinical outcomes of retrograde interlocked intramedullary nailing with tibia bone graft fusion in treating end-stage ankle arthritis.Methods:From November 2014 to April 2016,22 patients with end-stage ankle arthritis were treated with retrograde interlocked intramedullary nailing with tibia bone graft fusion,including 9 males and 13 females aged from 30 to 65 years old with an average of 48.5 years old.Seven patients had obvious varus deformity,and other 15 patients' appearance were normal.Operative time,blood loss,fracture healing time and complications were observed and compared,AOFAS and VAS score were applied for evaluate ankle joint function and pain degree before operation and 9 months after operation.Results:All patients were followed up from 12 to 24 months with an average of 18.6 months.The incision were healed at stage Ⅰ,and no complications occurred.Operative time ranged from 80 to 120 min with an average of 90 min;blood loss ranged from 15 to 50 ml with an average of 30 ml;fracture healing time was from 10 to 18 weeks with an average of 14 weeks.AOFAS score at 9 months after operation was 88.00±3.45,while 54.82±2.98 before operation,and there was statistical significance;8 cases obtained excellent results,12 good and 2 moderate.There was significant difference in VAS score between preoperative (3.96±1.27) and 9 months after operation (9.37±0.55).Conclusion:Retrograde interlocked intramedullary nailing with tibia bone graft fusion for the treatment of end-stage ankle arthritis has advantages of stable fixation,less trauma,less blood loss,bone union and rapid recovery of function,and could relieve pain obviously.