摘要
目的评估踝上截骨术治疗中期内翻型踝关节骨关节炎(OA)的临床疗效。方法回顾分析2009年4月至2014年4月西安交通大学医学院附属红会医院行踝上截骨术的41例内翻型踝关节OA患者的病历资料。其中,男14例,女27例,平均年龄50. 7岁(32～71岁)。根据改良Takakura踝关节炎分期:2期14例,3A期19例,3B期8例。保留腓骨组19例,腓骨截骨组22例。采用美国足踝外科协会(AOFAS)踝-后足功能评分、Maryland足部评分踝关节OA量表(AOS)评估临床疗效,并比较踝关节活动度(ROM)。影像学测量内容包括胫骨前侧关节面角(TAS)、距骨倾斜角(TT)、胫骨踝穴角(TC)及胫骨侧位关节面角(TLS)。选取8具新鲜下肢标本,通过踝上截骨建立胫骨远端内外翻模型。通过Tek Scan踝关节压敏片测试关节接触面积、接触压强及峰值压强,观察胫距关节受力中心的位置变化,并比较保留腓骨与截除腓骨的影响。结果平均随访时间36. 6个月(16～55个月)。3例延迟愈合,2例因术后疼痛和功能障碍行踝关节融合。末次随访时,AOFAS评分与Maryland评分均较术前显著增高[(83. 1±9. 6)分vs.(50. 8±13. 6)分,(81. 6±6. 0)分vs.(58. 3±12. 0)分,P均<0. 01],AOS疼痛评分与功能评分较术前均显著增高[(42. 6±5. 5)分vs.(26. 1±5. 2)分,(53. 4±12. 3)分vs.(36. 8±10. 5)分,P均<0. 01],而Takakura分期较术前显著降低[(2. 3±0. 9)分vs.(2. 8±0. 7)分,P <0. 01],ROM未获得显著改善(P=0. 097)。影像学测量结果显示,除TLS外TAS、TT、TC均较术前显著改善(P均<0. 01)。保留腓骨组与腓骨截骨组的临床功能评估指标差异均无统计学意义(P> 0. 05);但腓骨截骨组的TT和TC改善程度较保留腓骨组显著(P均<0. 05)。保留腓骨时,5种工况间关节接触面积、接触压强及峰值压强无显著差异(P均> 0. 05);内翻模型胫距关节受力中心向前外侧移位,外翻模型受力中心向后内侧移位。截除腓骨时,关节接触面积及峰值压强在1
Objective To evaluate the clinical and imaging effects of supramallicular osteotomy in the treatment of mid-tell1 varus ankle arthritis, and to compare the effects of fibula preservation and fibula amputation on clinical and imaging results. Methods The data of 41 patients with varus ankle arthritis treated by supramallicular osteotomy were analyzed in Honghui Hospital of Xi＇ an Jiao Tong University Medical College from April 2009 to April 2014, retrospectively. There were 14 males and 27 females with an average age of 50.7 years （ 32-71 years） , 14 patients with modified Takakm＇a ankle arthritis stage 2, 19 patients with stage 3A and 8 patients with stage 3 B. Nineteen patients were fibula preservation group, and 22 patients were fibula amputation group. Their American Orthopedic Foot and Ankle Society （AOFAS） and ankle osteoarthritis scale （AOS） were used to evaluate the clinical efficacy, and the ranges of motion （tlOM） were compared, hnaging measurements included tibial anterior surface angle （TAS）, talar tilt angle （ff）, tibial ankle angle （TC） and tibial lateral surface angle （TLS）. The distal tibial varus and valgus models were established with selecting 8 fi＇esh lower limb specimens and the upper ankle osteotomy. The contact area, contact pressure and peak pressure of the ankle joint were measured by TekSean pressure sensitive film to observe the change of tibial talus force center and compare the effects of fibula preservation and osteotomy. Results The average follow-up time was 36.6 months （16-55 months）. There were 3 patients with delayed union and 2 patients undergone ankle arthrodesis due to postoperative pain and dy-sfunetion. At the last follow-up, the AOFAS score and Maryland score were significantly higher than that at preoperation [ （83.1 ±9.6） vs. （50.8 ± 13.6）, （81.6 ±6.0） vs. （58.3 ± 12.0） ,all P 〈 0.011, and ROM was not significantly different （P = 0. 097 ）. The AOS pain score and functional score were significantly higher
作者
梁晓军
Liang Xiaojun(Department of Foot and Ankle Surgery,Honghui Hospital of Xi＇an Jiao Tong University Medical College,Xi＇an 710054,China)
出处
《骨科临床与研究杂志》
2018年第6期323-328,共6页
Journal Of Clinical Orthopedics And Research
关键词
踝关节
骨关节炎
截骨术
生物力学
力线矫正手术
Ankle joint
Osteoarthritis
Osteotomy
Biomechanics
Force line correction surgery
