关节镜辅助下足踝关节融合术

Arthroscopically assisted foot and ankle joint arthrodesis

目的探讨关节镜辅助下足踝关节融合术的方法与疗效。方法2001年1月-2004年7月,采用关节镜辅助下踝关节融合术13例,距舟关节融合术8例。男15例,女6例;年龄32-68岁,平均41岁。其中踝关节粉碎性骨折伴创伤性骨关节炎6例,地方性大骨节病7例,距舟关节炎8例;左足9例,右足12例。镜下清除踝关节和距舟关节增生肥厚的滑膜和纤维瘢痕组织,磨削骨赘,切除胫骨端、距骨穹隆和内外侧踝穴的软骨和软骨下骨,进行自体骨植骨。为保证骨对骨的密切接触需进行内固定。结果术后均获得随访,时间6-38个月,平均10个月。术后关节无肿胀和疼痛,行走步态和功能明显改善,X线片显示骨性融合。结论关节镜辅助下进行踝关节和距舟关节融合,不仅创伤小、视野清晰、操作简便,而且不破坏周围结构,有利于融合并保留踝穴轮廓。

Objective To study the methods and value of arthroscopically assisted foot and ankle joint arthrodesis. Methods From January 2001 to July 2004, under arthroscopical assist, ankle joint arthrodesis was undertaken in 13 cases and talonavicular joint arthrodesis in eight, in which 15 cases were male and six female, with average age of 41 years ( age range from 32 to 68 years). There were six cases with traumatic osteoarthritis of ankle joint, seven with Kashin-bek syndrome and degenerative osteoarthri-tis of ankle joint and eight with talonavicular articulation osteoarthritis. Under arthroscope, osteophytes, scar tissue, osteochondral fragment and cartilage were removed or cleared so as to do autogenous bone grafting. At the same time, internal fixation was necessary in order to reach the state that bone contacted closely. Results All the cases were followed up for 6-38 months (average 10 months). No pain or swell appeared. The walk gait and function showed a significant improvement and X-ray verified the bone fusion. Conclusion Arthroscopically assisted foot and ankle joint arthrodesis is characterized by less invasion, clear view and simple manipulate and is beneficial to arthrodesis and reservation of contour of ankle coel without destruction of peripheral structures.