摘要
目的总结和评价踝上截骨矫正术治疗踝关节创伤后畸形愈合的手术方法和疗效。方法选取2009年2月至2012年12月采用踝上截骨矫正术治疗踝关节创伤后畸形愈合的患者33例。女20例,男13例。年龄34~64岁,平均44.5岁。接受单纯踝上胫骨截骨20例,踝上胫腓骨截骨13例。比较患者手术前后正、侧位X线片上胫骨前面角（tibial anterior surface angle,TAS）和胫骨侧面角（tibial lateral surface angle,TLS）的差异。应用视觉模拟量表（VAS）对患者疼痛情况进行评价。应用美国足踝外科协会后足与踝关节（AOFAS-HA）评分法对患者手术前后功能情况进行评价。结果平均随访38.7个月（24~78个月）。所有患者均达到骨性愈合,平均骨愈合时间为7~8周。AOFAS-HA评分从术前平均40.7分提高到术后12个月时的平均79.8分。VAS评分从术前的平均7.4分降低到术后12个月时平均1.3分。TAS术后12个月平均93.9°,较术前平均改善7.5°。TLS不正常者2例,术前平均70.0°,术后12个月时平均81.5°。2例患者术后发生切口延迟愈合,经伤口护理后愈合。截止末次随访,21例患者对手术效果表示非常满意,12例患者比较满意。结论踝上截骨术治疗踝关节创伤后畸形效果好,选择合适指征的患者,该术式能够纠正力线,延缓踝关节创伤性关节炎的发生。
Objective To summarize the surgical method and evaluate the effect of supramalleolar osteotomy on the malalignment after ankle fracture. Methods Selection in February 2009 to December 2012, the 33 patients suffered from the malalignment after ankle fracture were treated with supramalleolar osteotomy in our department. There were 20 females and 13 males, aged 34~64, on average 44.5 years old. Of them, 20 patients received the supramalleolar tibial osteotomy and 13 received supramalleolar tibial and fibular osteotomy. The VAS score, AOFAS-HA score, and radiographic examinations including the tibial anterior surface angle（TAS） and the tibial lateral surface angle（TLS） in the anteroposterior and lateral radiographs were compared before and after surgery. Results The follow-up was carried on for 24~78 months, on average 38.7 months. All patients got the bone healing and the average healing time was 7~8 weeks. The AOFAS-HA score was increased from 40.7 to 79.8 in the 12 th month after the operation. The VAS score was decreased from 7.4 to 1.3 in the 12 th month after the operation. The TAS before the operation was 86.1° and in the 12 th month after operation 93.9°, the improvement was 7.5° on average. The TLS in 2 patients was abnormal, before operation 70.0° on average, and improved to 81.5° on average in the 12 th month after the operation. Delayed wound healing occurred in 2 cases, but it was solved with wound care. At the end of follow-up, 21 patients were satisfactory and 12 said OK about the effect of treatmen. Conclusions The supramalleolar osteotomy is a sound method for treating malalignment after ankle fracture. This procedure is able to correct the contact pressure on the degenerated cartilage with mechanical realignment to delay the development of traumatic arthritis.
作者
朱渊
徐向阳
刘津浩
王碧菠
杨崇林
李星辰
ZHU Yuan XU Xiang-yang LIU Jin-hao WANG Bi-bo YANG Chong-lin LI Xing-chen(Department of Orthopaedics, Ruijin Hospital, Shanghai Jiaotong University, Shanghai 20002)
出处
《足踝外科电子杂志》
2015年第2期11-14,共4页
Electronic Journal of Foot and Ankle Surgery
关键词
踝截骨
关节炎
创伤后畸形愈合
Ankle osteotomy
Arthritis
Abnormal healing after the traumatic injury
