人工关节在踝关节残障中的应用及随访

The application and followed-up result with total ankle arthroplasty and autografing for ankle disabled persons

[目的]观察植骨人工踝关节置换治疗踝关节病损的中远期疗效。[方法]自1998年10月～2008年12月,植骨人工踝关节置换治疗踝关节损伤性关节炎56例(其中伴距骨体顶部局限性坏死2例和胫骨骨折并小腿筋膜间室综合征广泛肌切除后距下关节融合1例),类风关1例。男35例,女22例;平均年龄54.7岁(28～68岁)。[结果]本组57例获平均6年9个月随访(2年10个月～10年3个月)。术前、术后踝关节功能采用Kofoed评价法和步态分析,术前踝关节功能62分(60～75)13例,47分(30～60)27例,16分(0～29)17例。术后效果优(85～100分)39例,良(75～84分)14例,差(60～74分)1例。优良率98.3%。术前、术后疗效按Kofoed评价以统计学分析,P<0.01具有显著意义。术前步态49例均为跛行步态(负重相>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(负重相>55%)3例。未行步态分析8例。术前、术后步态分析两组数据的统计学分析P<0.05,有统计学意义。X线检查显示植骨部与假体间固定良好,植骨成活。[结论]植骨人工踝关节置换对改善创伤性踝关节炎等疾患的功能有良好疗效。

[Objective]To study the therapetic results of the ankle arthroplasty with autografing in treatment of ankle traumatic osteoarthritis for ankle disabled persons. [Method]Sinee October,1998 to December,2008,total ankle replacement with autografing was emplayed to treat 56 cases of traumatic osteoarthritis（among two local necrosis of the talus,and one occurred after ankle and subtalar joint arthrodesis for tibial fracture and osteofascial compartment syndrome）.There were 35 men and 22 women.Their ages ranged from 28 to 68 years,averaging 54.7 years. [Result]In this grop,57 patiens were followed up for a mean time of 6 years and 9 months（2 years and 10 months to 10 years and 3 months）.The ankle function was evaluated by Kofoed＇s system and gait analysis system in pre-and post-operatin.In preoperative,the ankle function score were mean 62 pionts（60-75） in 13 cases,47 pionts（30-60）in 27,16 points（0-29） in 17.The score of postoperation was excellent（85-100） in 39 patients,good（75-84） in 14,poor（60-74） in one.The overall excellent and good rate was 98.3%.The sore of the ankle function at post-operative compared with pre-operative with significant differences in this group（P〈0.01）.Forty-nine cases in gait analysis scanning system at pre-operative were lame（in standing phase55%）.But normal gait（in phase 15%-45%） was in 24 cases,light-lame（standing phase 45%-55%） in 22,and lame gait（stand phase55%） in 3 during post-operative observation.It were found better in the post-operative gait group than in the pre-operative group（P〈0.05）.The X-ray showed fixation between prothesis and autographing were succesful and live at followed up. [Conclusion]Total ankle replacement with autografing is a good method for improvement of the ankle function.