人工踝关节置换49例7年8个月随访报告

Total ankle arthroplasty:long-term results of 49 ankles

[目的]观察人工踝关节置换治疗踝关节病损的远期疗效。[方法]自1997年10月～2007年12月,人工踝关节置换治疗踝关节疾患56例,包括踝关节骨关节炎28例,类风关2例,创伤性踝关节炎26例,其中距骨局限坏死2例,胫骨骨折小腿筋膜间室综合征小腿肌广泛切除后踝关节距下关节融合后1例。男44例,女12例;平均年龄48.2岁(28～66岁)。[结果]除6例失访外,余49例获平均7年8个月(3年～10年7个月)随访。术前、后踝关节功能采用Kofoed评价法和步态分析,术前踝关节功能62分(60～75)14例,42分(16～59)35例;术后优(85～100分)35例,良(75～84分)12例,差(60～74分)2例,无失败(<60分)患者,优良率96.6%。统计学分析(P<0.01)具有显著意义。术前步态49例均为跛行步态(站立相超过55%);术后正常步态(15%～45%周期内)24例,轻微跛行(站立相45%～55%)22例,跛行(站立相超过55%)3例。术前、术后步态分析两组数据的统计学分析(P<0.05)有意义。[结论]人工踝关节置换对改善踝关节功能有良好疗效。

[ Objective ] To investigate the therapeutic results of ankle arthorplasty in treatment of ankle disorders. [ Methotis] From October 1997 to December 2007, total ankle arthroplasty was performed in 28 patients with osteoarthritis, in which 3 with rheumatoid arthritis, and 28 with traumatic arthritis. They were 37 male and 12 female. Their ages ranged from 28 to 66 years, averaging 48.2 years. [Results] Except 7 cases loosed, 49 patients were followed up for a mean time of 7 years and 8 months （3 years to 10 years and 7 months） . The ankle functions were evaluated by Kofoed＇ s system and gait analysis system at pre - and postoperation. In preoperation, the ankle function score was 66 （60 -75 ） on average in 14 patient and 42 （ 16 -59 ） in 35. Tie scoer of post -operation was excellent （85 -100） in 35 cases, good （75 -84） in 12, poor （60 -74） in 2, and disabled （〈60） in none. The overall excellent and good rate was 96. 6%. The score of the ankle function at post - operation compared with pre - operation showed significant differences in this group （ P 〈0. 01 ） . Forty - nine cases in gait analysis scan- ning system at preoperation were lame, in standing phase 〉55%. But normal gait （in phase 15% -45% ） was gain in 24 ca- ses, ligt - lame （ stanging phase 45% - 55% ） in 22, and lame gait （ standing phase 〉 55% ） in 3 during postoperation. It were found better in the post - operative gait than in the pre - operative （ P 〈 0. 05 ） . [ Conclusion ] Total ankle arthroplasty is a good method for improvement of the ankle function.