摘要
目的探讨采用联合小切口下全螺纹无头加压螺钉行胫-距-跟融合术的临床疗效。方法 2012年1月—2016年12月,对36例(36足)踝关节疾病患者采用联合前踝正中纵切口及外踝跗骨窦小切口下2枚全螺纹无头加压螺钉加压固定行胫-距-跟融合术治疗。男14例,女22例;年龄18~76岁,平均53.8岁。左足19例,右足17例。距骨塌陷性坏死21例,创伤性关节炎7例,类风湿性关节炎3例,结核感染(非活动性)2例,距骨缺如1例, Charcot关节病1例,踝及距下关节绒毛结节性滑膜炎1例。术前美国矫形足踝协会(AOFAS)评分为(53.7±2.5)分,疼痛视觉模拟评分(VAS)为(5.9±0.2)分。记录手术时间、术后患者切口愈合以及并发症发生情况,X线片及CT检查关节面是否达骨性融合,AOFAS评分和VAS评分评价关节功能及疼痛情况。结果手术时间33~82 min,平均49.8 min。术后3周1例(2.8%)发生切口皮肤感染,经清创、换药后痊愈;其余患者切口均Ⅰ期愈合,无相关并发症发生。术后35例患者获随访,随访时间12~29个月,平均18.5个月。影像学检查示均达骨性融合,融合时间8~15周,平均10.9周。术后1年,AOFAS评分为(84.7±0.6)分,VAS评分为(0.3±0.1)分,与术前比较差异均有统计学意义(t=12.596,P=0.000;t=30.393,P=0.000)。结论采用联合小切口下全螺纹无头加压螺钉固定行胫-距-跟融合术具有并发症少、术后融合率高等特点,是治疗踝关节终末期疾病有效术式。
Objective To investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions. Methods Between January 2012 and December 2016, 36 patients（36 feet） with ankle diseases underwent tibio-talo-calcaneal arthrodesis with parallel double thread headless compression screws via minimal anterior and lateral oblique incisions. There were 14 males and 22 females with an average age of53.8 years（range, 18-76 years）. There were 19 cases of left feet and 17 cases of right feet. There were 21 cases of talar necrosis, 7 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 2 cases of tuberculosis infection（inactive）,1 case of talar absence, 1 case of Charcot＇s disease, and 1 case of pigmented villonodular synovitis of ankle and subtalar joints. Preoperative American Orthopaedic Foot and Ankle Society（AOFAS） score and visual analogue scale（VAS）score were 53.7±2.5 and 5.9±0.2, respectively. The operation time was recorded and the wound healing and complications were observed. The bone healing was assessed by X-ray film and CT scanning. The function and pain of joint were evaluated by AOFAS and VAS scores. Results The mean operation time was 49.8 minutes（range, 33-82 minutes）.Incision infection occurred in 1 patient（2.8%） at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of18.5 months（range, 12-29 months）. Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks（range, 8-15 weeks）. After 1 year, the AOFAS score（84.7±0.6） and VAS score（0.3±0.1） were significantly higher than preoperative scores（t=12.596, P=0.000; t=30.393, P=0.000）. Conclusion It is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle
作者
杨明宇
谢美明
龚继承
周兵华
穆米多
陈雍华
唐康来
YANG Mingyu;XlE Meiming;GONG Jicheng;ZHOU Binghua;MU Miduo;CHEN Yonghua;TANG Kanglai(Department of Orthopedics/Sports Medicine Center,the First Affiliated Hospital of Army Medical University（the Third Military Medical University）,Chongqing,400038,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2018年第10期1297-1301,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家重点研发计划资助项目(2016YFC1100500)
国家自然科学基金资助项目(81230040
81572133)
重庆市社会民生科技创新专项(SSTC2016shmszx130013)~~
关键词
胫-距-跟融合术
踝关节
距下关节
全螺纹无头加压螺钉
小切口
Tibio-talo-calcaneal arthrodesis
ankle
subtalar
full thread headless compression screw
minimal incision
