经外踝入路关节内环锯法行踝关节融合术

Clinical application of trephine for arthrodesis of the ankle via lateral approach

[目的]介绍经外踝入路关节内环锯法行踝关节融合术的方法与临床效果。[方法]利用环锯（Ф14mm、16mm、18mm）对20例踝关节严重病损病人行关节融合术，均采用踝关节外侧入路，腓骨下段截骨并下翻显露关节，利用环锯关节内融合即原锯心骨旋转90°原位回植，外踝骨块螺钉固定旁靠植骨。术后关节予以石膏固定。[结果]经随访6个月～4a，平均26个月。术后2周刀口Ⅰ期愈合，4周可见骨痂形成，12周病人疼痛明显缓解或消失，足部外形改善。X线片示胫距关节牢固融合。[结论]采用经外踝入路关节内环锯法行踝关节融合术，方法简单，融合率高。其优点为：切口显露良好；对胫距关节干扰小，保证了关节的正常高度和下肢长度；锯心骨原位回植无需再次植骨，外踝旁靠植骨提高了植骨强度。

[ Objective] To introduce a new technique of ankle arthrodesis with trephine by lateral approach and evaluate its clinical effects. [ Method] Ankle arthrodesis with trephine was performed in 20 patients with serious lesions. Lateral incision was adopted and osteotomy of fibula facilitated the exposure of the fusion site. A trephine of appropriate diameter was used for bi-osteotomy, thus inside the trephine gaining two bone blocks were then rotated 90° and replanted in situ. The pruned fibula was fixed with screws as on-lay grafting. Proper cast was utilized postoperatively to maintain a functional position. [ Result] The average follow-up period was 26 months （ranged from 6 months to 4 years）. All the wounds healed well at 2 weeks and the callus appeared 4 weeks postoperatively. Sufficient pain relief was obtained in all patients at 12 weeks and appearance improved greatly . A solid union was achieved in all cases through the radiograph. [ Conclusion]The use of trephine in ankle fusion by lateral approach is proved to be a simple technique with high union rate. The main advantages of the technique over other methods of arthrodesis include ： excellent exposure by regular incision ; less disturbance of the original joint, thereby preserving normal height of the joint and length of the extremity ; no need for extra graft through in-situ grafting of the bone blocks and rigid on-lay grafting of lateral malleolus for high primary stability.