胫骨开槽与环锯法踝关节融合后临近关节退变的比较

Effect of tibia slotting versus trephine for ankle fusion on the degeneration of the adjacent joint

背景：由于踝关节的特殊解剖结构,踝关节融合的方法较多并各有优势。目的：比较胫骨开槽法及环锯法行踝关节融合的临床疗效。方法：于2002-02/2011-02对苏州大学附属第一人民医院骨科招募的35例行踝关节融合的患者,分别采用胫骨开槽（n=19）及环锯截骨法（n=16）治疗,并对其进行随访观察比较。结果与结论：所有35例患者均获随访,随访时间为8~96个月。胫骨开槽方法比环锯法踝关节融合手术时间长（P〈0.05）,术中出血量多（P〈0.05）。术后8个月胫骨开槽组患者美国足踝外科协会评分高于胫骨开槽组（P〈0.05）,胫骨开槽组有10例,环锯法有8例随访满5年,2组患者术后均有〉1/3的患者出现临近关节退变症状。提示相较于环锯截骨法,环锯法行踝关节融合具有创伤小,操作简单,融合率高,并发症少等优点,但踝关节融合后临近关节的退变也不可忽视。

BACKGROUND：Because of the special anatomy of the ankle joint,there are many methods in ankle fusion,and each has its own advantages.OBJECTIVE：To analyze and compare the effect of tibia slotting versus trephine for ankle fusion discuss the degeneration of adjacent joints.METHODS：A retrospective study was carried out in 35 patients with ankle from February 2002 to February 2011 in the First Affiliated People＇s Hospital of Soochow University.We used trephine（n=16） and slotted（n=19） in the tibia to fuse the patients＇ ankle joint,then the effect was analyzed and compared.RESULTS AND CONCLUSION：All the 35 patients were followed-up for 8-96 months.The duration of ankle arthrodesis by tibia slotting was longer than that by trephine（P 0.05）,and the intraoperative blood loose was more（P 0.05）.The average American College of Foot and Ankle Society score at the 8th month follow-up in the tibia slotting group was higher than that in the trephine group（P 0.05）.Eighteen of the 35 patients were followed-up for at least 5 years,10 cases in the tibia slotting group and 8 cases in the trephine group.Over one third of the patients in both two groups occurred adjacent joint degeneration.Compared with slotting in the tibia,trephine for ankle arthrodesis was a simple operation with small wound,higher fusion rate and less complications.However,the degeneration of the near joint should not be ignored.