小切口经皮空心螺钉内固定行距下关节融合术治疗距下关节炎

Subtalar fusion with mini-incision and percutaneous cannulated screws for treatment of subtalar arthritis

目的 探讨单纯小切口经皮空心螺钉内固定行距下关节融合术治疗距下关节炎的临床疗效.方法 2006年1月至2009年12月对26例（27足）保守治疗6个月以上无效的距下关节炎患者行距下关节融合治疗,男13例,女13例;平均年龄38.7岁（26～73岁）;左侧11足,右侧16足.其中创伤性关节炎16例16足,类风湿关节炎6例7足,骨关节炎4例4足.术前平均病程8.3个月（6～25个月）.手术采用外侧约4 cm切口,通过经皮穿针平行钻入2枚空心螺钉予以固定.术前和末次随访时采用视觉模拟法（VAS）疼痛评分和美国足踝外科协会（AOFAS）踝与后足评分分别对疼痛和功能进行评估.同时采用X线摄片和CT扫描进行影像学评估. 结果 26例患者术后获平均18 5个月（6～47个月）随访.术前与末次随访时VAS疼痛评分分别为（6.9±0.7）、（1.5±0.3）分,差异有统计学意义（t=17.000,P=0.000）;AOFAS踝与后足评分分别为（54.3±12.1）、（82.6±11.3）分,差异有统计学意义（t=6.308,P=0.000）.术后X线片或CT示26例患者全部获骨性融合,平均融合时间为10.8周（10～14周）. 结论 小切口经皮穿针空心螺钉内固定行距下关节融合术治疗距下关节炎具有创伤小、恢复快、并发症少等优点,易于推广.

Objective To discuss subtalar fusion with mini-incision and percutaneous cannulated screws for treatment of subtalar arthritis. Methods From January 2006 to December 2009, 26 patients （27 feet） underwent subtalar fusion due to serious subtalar joint arthritis which had not responded to conservative treatment for more than 6 months. They were 13 males and 13 females, with an average age of 38.7years （26 to 73 years） . The arthritis involved 11 left and 16 right feet, with a mean disease course of 8.3months （6 to 25 months）. The subtalar joint was explored laterally by an incision of about 4 cm and fixed with2 percutaneous cannulated screws. All patients were evaluated preoperatively and postoperatively by the American Orthopaedic Foot ＆ Ankle Society （AOFAS） scoring system for functions of the ankle and hind foot and by the visual analogue scale （VAS） score for pain. All patients were evaluated by X-ray and CT scan.Results All patients were followed up for 6 to 47 months （mean, 18.5 months）. The VAS scores increasedfrom 6.9 ± 0.7 points preoperatively to 1.5 ± 0. 3 points postoperatively（ t = 17. 000, P = 0. 000）. The mean AOFAS ankle-hindfoot scores increased from 54.3 ± 12.1 points preoperatively to 82. 6 ± 11.3 points postoperatively（ t = 6. 308, P = 0. 000）. All patients got good fusion after a mean time of 10. 8 weeks （ 10 to 14weeks） . Conclusion The subtalar joint fusion with mini-incision and percutaneous cannulated screws may acquire good clinical outcomes, with minimal invasion, fast recovery and few complications.