关节镜下胫骨交锁髓内钉融合术治疗类风湿踝关节炎

Arthroscopic arthrodesis for treatment of ankle rheumatoid arthritis with tibia interlocking nail

目的观察关节镜下胫骨交锁髓内钉融合术治疗类风湿踝关节炎的临床疗效。方法 2008年6月至2011年10月,选择30例(30踝)类风湿踝关节炎患者,在关节镜下行普通胫骨交锁髓内钉踝关节融合手术。术后平均随访20个月(6～36个月),根据美国足踝外科协会(AOFAS)踝与后足功能评分对所有患者进行评分。结果手术前后AOFAS踝与后足功能评分由术前平均54.3分(40～65分)提高到术后平均79.6分(61～89分)。术后无疼痛27例,轻度疼痛3例。未出现血管神经损伤、骨不连、骨延迟愈合和感染等并发症。所有患者踝后足对线良好,30踝均获骨性融合,融合率100%。结论关节镜下胫骨交锁髓内钉融合术可有效缓解踝关节疼痛,改善关节功能,对患侧下肢活动、负重未见不良影响,是一种治疗类风湿踝关节炎的安全有效方法。

Objective To observe the effect of arthroscopic arthrodesis for treatment of ankle rheumatoid arthritis. Methods Thirty cases （30 ankles） of ankle rheumatoid arthritis were treated by arthroscopic arthrodesis with tibia interlocking nail from June 2008 to October 2011 in our hospital. The cases were followed up with average of 20 months （ranges, 6 to 36 months）. The American Orthopaedic Foot and Ankle Society （AOFAS） ankle^hindfoot scale was used to evaluate the clinical effect. Results The preoperative mean AOFAS score was 54. 3 （ranges, 40 to 65）, and the postoperative was 79. 6 （ranges, 61 to 89） after the last follow up. Twenty-seven patients reported no pain and 3 mild pain. There were no neurovascular structures damage, nonunion, delayed union and infection. All ankle hindfoot line was good. Fusion occurred in 30 of 30 （100~）. Conclusions Arthroscopie arthrodesis with tibia interlocking nail could relieve pain and improve the function effectively. There are no observable adverse effects for lower limbs action and weight-bearing. It is a safe and effective treatment to ankle rheumatoid arthritis.