人工全踝关节置换35例(英文)

Total ankle replacement in 35 cases

华中科技大学附属协和医院与南昌大学第一附属医院于1999-03/2006-11采用STAR非限制活动负重型假体对35例患者行全踝关节置换。年龄27～68岁,平均50.5岁。其中左侧20例,右侧15例;创伤性关节炎12例,骨性关节炎8例,类风湿性关节炎15例。患者均有踝关节疼痛,不同程度的肿胀及关节活动受限。术中出现内踝骨折2例,踝关节内翻不稳定2例,踝关节背伸范围不足1例,均对症处理。术后足背中部及3～5趾相对缘皮肤感觉减退1例,无明显运动功能障碍,未作特殊处理。术后2例切口感染经换药后延迟愈合,33例切口I期愈合。28例获随访3～80个月,平均43.5个月。28例患者踝关节Kofoed总评分58～95分,平均85.5分;疼痛评分35～50分,平均48.3分;功能评分18～30分,平均20.7分;活动度评分16～20分,平均17.2分,均高于术前(P<0.01)。X射线片检查均未见假体松动或下沉。提示标准化、规范化操作技术,采用与假体紧密配套的手术工具防治术后感染、脱位、假体松动等材料与宿主的组织相容性反应是提高假体置换成功率的必要条件。

Thirty-five patients who underwent Scandinavian total ankle replacement （STAR） in the Union Hospital, Huazhong University of Science and Technology ＆ First Affiliated Hospital of Nanchang University between March 1999 and November 2006 were recruited for this study. The patients averaged 50.5 years old ranging from 27 to 68 years old. STAR was performed on the left side in 20 cases and on the right side in 15 cases. Among these patients, 12 suffered from posttraumatic arthritis, 8 osteoarthritis, and 15 rheumatic arthritis. All patients complained of ankle joint pain and different degrees of swelling as well as limited motion of joint. During the operation, some complications appeared, including medial malleolus fractures 2 patients, unstable ankle joint introversion 2 patients, limited ankle joint dorsiflextion 1 pateint. Symptomatic treatments were performed in these patients. Postoperatively, injury of superficial peroneal nerve occurred in 1 patient, but this did not cause an obvious motor dysfunction, so no special treatment was given. In addition, infection of incisional wound appeared in 2 patients and late healed subsequent to another dressing. Thirty-three cases presented with primary healing of incision. Among 35 total ankle arthroplasties, 28 had detained 43.5-month follow up （range 3-80 months） The ankles were scored with Kofoed total scoring system. The average postoperative ankle score was 85.5 （range 58-95）, pain degree score was 48.3 （range 35-50）, joint function score was 20.7 （range 18-30）, and range-of-motion score was 17.2 （range 16 20）. There was significant difference in these scores as compared to preoperative scores （P 〈 0.01）. None of prosthetic loosening and migration was found radiologically. All these indicated that standardized and normalized operative technique as well as operative tools closely matched to the prosthesis and used to prevent and treat postoperative infection, dislocation, and prosthetic loosening as well as histocompatibility between material and host are the essential conditions for enhancing the success rate of prosthetic replacement.