逆行交锁髓内钉治疗踝关节创伤性关节炎的临床观察

Clinical observations of retrograde intramedullary nail for traumatic arthritis of ankle joint

目的评价逆行交锁髓内钉用于踝关节创伤性关节炎关节融合的效果。方法采用关节间隙植骨融合加钛合金逆行交锁髓内钉固定术治疗踝关节退变9例，其中男4例，女5例。年龄40～70岁，平均41．6岁。手术距原发创伤的时间2～26年，平均12-4年。同种异体骨植入关节间隙，自跟骨向胫骨逆行置钉并常规作近、远端锁钉。结果术后平均随访17-4个月，术前、术后对患者行OFAS评分，并通过影像评价植骨融合效果。手术前后患者的AOFAS平均评分分别为44．1分（42—53分）和70分（57～86分）。8例（88．9％）达到植骨完全融合。结论植骨融合加逆行交锁髓内钉固定是治疗踝关节创伤性关节炎的有效方法。

Objective To evaluate the outcome of ankle joint fusion by using the locked retrograde intramedullary nail with graft in traumatic arthritis patients, Methods There were 9 patients （4 male, 5 female） with an average age of 41.6 years old （ranging from 40-70 years old）,all unilateral, the mean time between the procedure from primary trauma was 12.4 years（2 - 26 years）.Homograft bone was padded to joint space.The nail was inserted through a plantar approach with locking screws placed both proximally and distally. Results Patients were available for an average duration of follow-up of 17.4 months, and were evaluated by a standardized follow-up examination by using the AOFAS and the fusion outcome were observed radiogmphically. The average AOFAS score improved from 44.1 （ranged, 42 - 53） to 70（ranged, 57 - 86）points.Solid fusion has fully achieved in 8 ankles （88.9%）. Conclusions Locked retrograde intramedullary nail fusion with bone graft is effective for traumatic arthritis of ankle joint.