关节镜辅助下内固定踝关节融合术与开放性踝关节融合术治疗晚期创伤性踝关节炎的疗效对比

摘要

目的:对比关节镜辅助下内固定踝关节融合术与开放性踝关节融合术治疗晚期踝关节炎的疗效.方法:选取2013年3月至2014年3月湖北医药学院附属东风医院收治的晚期踝关节炎患者108例,按随机数字表法分为观察组和对照组,每组54例.对照组采用传统开放性躁关节融合术,观察组在关节镜辅助下行内固定关节融合术.比较两组患者的手术时间、术中出血量、术后住院时间、关节融合时间及并发症发生率.术后4周、8周及12周,分别采用视觉模拟评分法(VAS)和Ko-foed法评估患者踝关节疼痛程度和踝关节功能.术后24个月,采用美国矫形外科足踝协会(AOFAS)踝关节功能评分系统评价两组远期疗效.结果:观察组术中出血量少于对照组,手术时间、住院时间及关节融合时间均短于对照组(均P＜0.05).观察组并发症发生率为5.56％,显著低于对照组的25.93％(P＜0.05).观察组术后Kofoed评分明显高于对照组(P＜0.05),VAS评分低于对照组(P＜0.05).术后24个月,观察组AOFAS评分优良率为72.22％,明显高于对照组的57.41％(P＜0.05).结论:关节镜下内固定关节融合术治疗晚期创伤性踝关节炎的近、远期疗效均优于传统开放性踝关节融合术,能明显缩短患者的手术时间,减少术中出血量及并发症发生率.%Objective:To compare the effectiveness of arthroscopic arthrodesis and open ankle arthrodeses on the treatment of advanced traumatic arthritis (ATA).Methods:108 patients with ATA in our hospital from March 2013 to March 2014 were selected and randomly divided into an observation group and a control group,with 54 cases in each group.The patients in the control group received traditional open ankle arthrodesis,and those in the observation group received arthroscopic arthrodesis.The operation time,intraoperative blood loss,postoperative hospital days,the average joint fusion time,and the incidence of complications were compared.After 4,8 and 12 weeks of operation,The degree of ankle pain and the function of ankle joint were evaluated by visual analogue scale (VAS) score and Kofoed score,respectively.At 24 weeks postoperation,the long-term efficacy was assessed by American Orthopaedic Foot and Ankle Society (AOFAS) score.Results:The operation time,postoperative hospital days and joint fusion time were shorter,and the blood-loss volume was less in the observation group than those in the control group (P＜0.05).The incidence of complications was 5.56％,which was significantly lower than that in the control group (25.93％) (P＜0.05).The Kofoed score was higher,and the VAS score was lower in the observation group,compared with the control group (P＜0.05).The excellent rate of AOFAS score was 92.60％,which was markedly higher than that in the control group (75.93％) (P＜0.05).Conclusion:The short-term and long-term effects of arthroscopic ankle arthrodesis on ATA were superior to that of open ankle arthrodeses.Arthroscopic arthrodesis could obviously decrease the operation time,bleeding volume and the incidence of complications.