胫前肌腱外移联合踝上截骨治疗3b期内翻性踝关节炎的临床疗效

Clinical outcomes of anterior tibial tendon transfer combined with supramalleolar osteotomy in stage 3b of varus ankle osteoarthritis

探讨胫前肌腱外移联合踝上截骨治疗3b期内翻性踝关节炎的临床疗效。回顾性分析2018年1月至2021年5月于北京同仁医院行胫前肌腱外移联合踝上截骨的3b期内翻性踝关节炎患者的临床效果。共入组患者13例,男6例,女7例,年龄(57.8±9.3)岁。比较术前及末次随访时患者的踝、后足相关力线,疼痛视觉模拟评分(VAS)及美国足踝外科协会(AOFAS)踝-后足评分变化。13例患者经(33.5±13.4)个月的随访,胫骨关节面角(TAS)由术前的83.3°±2.4°增至术后的92.8°±1.7°,距骨倾斜(TT)由术前的12.3°±4.5°缩至术后的7.0°±4.7°,后足位移(FAO)由术前的-7.4%±2.8%增大至术后的-0.7%±2.2%,手术前后差异均有统计学意义(均P<0.001)。患者术后AOFAS踝-后足评分和疼痛VAS评分均较术前明显改善(均P<0.001)。本研究表明,胫前肌腱外移联合踝上截骨治疗3b期内翻性踝关节炎可取得良好的临床及影像学效果。

To investigate the clinical and radiographic results of anterior tibial tendon(ATT)transfer combined with supramalleolar osteotomy in stage 3b of varus ankle osteoarthritis.Totally 13 patients with stage 3b of varus ankle osteoarthritis who received ATT transfer combined with supramalleolar osteotomy in Beijing Tongren Hospital from January 2018 to May 2021 were recruited.There were 6 males and 7 females with a mean age of(57.8±9.3)years.The overall evaluations included the preoperatively and postoperatively radiographic alignments,visual analog scale(VAS)score,and the American Orthopaedic Foot&Ankle Society(AOFAS)clinical ankle-hindfoot scale.The mean follow-up period was(33.5±13.4)months.The tibial articular surface(TAS),talar tilt(TT),and foot and ankle offset(FAO)changed from 83.3°±2.4°to 92.8°±1.7°,12.3°±4.5°to 7.0°±4.7°,and-7.4%±2.8%to-0.7%±2.2%after the operation,respectively(all P<0.001).The AOFAS and VAS score improved significantly at the final follow-up when compared with those before the operation(both P<0.001).It indicated that ATT transfer after supramalleolar osteotomy can achieve good clinical and radiographic results in the treatment of varus ankle arthritis in Takakura stage 3b.