腓骨退旋延长术治疗外踝畸形愈合二期创伤性踝关节炎的疗效观察

Study of therapeutic effect of lengthening and rotational osteotomy of fibula on stageⅡtraumatic ankle arthritis with lateral malleolar malunion

目的观察腓骨退旋延长术治疗伴外踝畸形愈合的踝关节二期创伤性关节炎的疗效。方法对41例踝关节二期创伤性关节炎行踝上截骨术治疗，对其中21例伴外踝畸形愈合的患者行腓骨退旋延长术治疗，17例获得完整的随访资料。应用美国骨科足踝外科协会AOFAS踝关节功能评分系统进行评分。结果17例获得14～43个月（平均21．5个月）随访。骨折全部愈合，平均临床愈合时间13．3周（11—16周）。完全负重时间平均为12周（11—15周）。术前踝关节AOFAS评分为23～46分（平均27分），术后12个月评分为55～91分（平均80分），其中优5例，良8例，—般3例，差1例，优良率76．5％。术后1例发生切口皮缘部分坏死，经保守治疗痊愈。2例术后出现足外侧皮肤感觉麻木，2例患者在最近X线片显示关节炎有轻微进展。无螺钉松动、断裂及内固定失效等其他并发症。结论伴外踝畸形愈合的踝关节二期创伤性关节炎采用腓骨退旋延长术治疗，近期可获得满意效果。

Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for stageⅡ traumatic ankle arthritis with lateral malleolar malunion. Methods Twentyone patients suffering from stageⅡ traumatic ankle arthritis were treated with the lengthening operation of the fibula and 17 of them completed the whole follow-up. The function of ankles were assessed by the AO- FAS scoring system. Results During a mean 21.5 （ 14 - 43 ） months follow-up, all the fractures were healed in a mean time of 13.3 （ 11 - 16） weeks, and the mean time of total weight bearing was 12 （ 11 15） weeks. The mean score of the ankle function before the operation was 27 （23 - 46） and 12 months after the operation was 80 （55 -91 ）, in which outcomes were excellent in 5 cases, good in 8, mild in 3, and poor in 1, and the ratio of excellent and good outcomes was 76.5%. After the operation, skin necro- sis around the wound occurred in 1 patient which was healed by expectant treatment, anaesthesia of the lateral side of the foot occurred in 2 patients, and the X ray of 2 patients indicated a slightly aggravated degeneration of ankle. None of them had a loosening or breakage of screws, or failure of internal fixation. Conclusion The lengthening operation of the fibula could come to a good outcome in the early postoperative period for the stage Ⅱ traumatic ankle arthritis with lateral malleolar malunion.