经外踝截骨锁定钢板内固定行踝关节融合

ANKLE ARTHRODESIS BY LATERAL MALLEOLUS OSTEOTOMY AND INTERNAL FIXATION WITH LOCKING PROXIMAL HUMERAL PLATE

目的总结经外踝截骨锁定钢板内固定行踝关节融合的手术方法和临床疗效。方法 2009年3月-2010年6月,收治18例踝关节疾病患者。男10例,女8例;年龄36～67岁,平均48岁。创伤性关节炎8例,类风湿性关节炎3例,骨关节炎5例,距骨创伤后坏死2例。病程1～6年,平均3年。主要临床症状为踝关节肿胀、疼痛,活动受限。合并踝关节内翻4例,外翻2例。根据美国矫形足踝协会(AOFAS)踝与后足评分标准,评分为(43.5±10.2)分。采用腓骨外侧入路经外踝截骨锁定钢板内固定行踝关节融合术。结果术后出现1例切口浅表感染,1例切口边缘坏死,经对症治疗后愈合。其余患者切口均Ⅰ期愈合,无早期并发症发生。16例患者获1年以上随访,随访时间1～2年,平均16个月。X线片示植骨均于术后8～16周达骨性融合,平均12周。末次随访时患者关节疼痛完全缓解,无内固定失败、畸形愈合、融合失败等并发症发生。AOFAS踝与后足评分为(83.0±6.3)分,与术前比较差异有统计学意义(t=26.20,P=0.00)。结论采用腓骨外侧入路经外踝截骨锁定钢板内固定行踝关节融合,手术操作简便,固定强度可靠,融合率高,具有良好的临床疗效。

Objective To summarize the surgical technique of ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation, and to evaluate the clinical effectiveness. Methods Between March 2009 and June 2010, 18 patients with ankle joint disease were treated, including 8 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 5 cases of osteoarthritis, and 2 cases of post-traumatic necrosis of talus. There were 10 males and 8 females with an average age of 48 years （range, 36-67 years）. The average disease duration was 3 years （range, 1-6 years）. The main symptoms included swelling, pain, and a limited range of motion of the ankle. Four patients accompanied with ankle varus deformity and 2 patients with valgus deformity. According to American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hindfoot score system, the preoperative score was 43.5 ±10.2. An ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation was performed in all patients. Results Superficial wound infection and partial skin necrosis occurred in 1 case respectively, and were cured after symptomatic treatment; the other incisions healed by first intention without complications. Sixteen patients were followed up 16 months on average （range, 1-2 years）. The X-ray films showed that bone fusion was obtained at 8-16 weeks （mean, 12 weeks） after operation. The symptom was relieved completely in all patients at last follow-up without complication of implant failure, nonunion, and malunion. The postoperative AOFAS ankle and.hindfoot score was 83.0±6.3, showing significant difference when compared with the preoperative score （t=26.20, P=0.00）. Conclusion Ankle arthrodesis using lateral malleolus osteotomy and locking proximal humeral plate internal fixation has the advantages of feasible technique, the rigid fixation, and high fusion rate, so it may obtain a good clinical effectiveness.