经外踝截骨锁定钢板固定的胫距跟关节融合术的应用

Tibiotalocacaneal arthrodesis by lateral malleolus osteotomy and fixation with proximal humeral internal locking system

目的总结经外踝截骨锁定钢板固定行胫距跟关节融合术的手术方法和临床疗效。方法对2008年12月至2010年3月收治的11例踝关节炎患者进行回顾性分析，男7例，女4例；年龄33～67岁，平均48．1岁；原发疾病包括：创伤性关节炎6例，骨关节炎3例，距骨坏死2例；平均病程2年（1～3年）。术前根据美国足踝外科协会（AOFAS）踝与后足评分标准评分为（45．5±11．1）分（30～64分）。手术采用经外踝截骨锁定钢板内固定行胫距跟关节融合术。结果术后有1例患者出现伤[J浅表感染，经清创换药后愈合。10例患者获平均24个月（12～36个月）随访。所有随访患者影像学证实术后平均12周（10～16周）融合处骨性愈合。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。末次随访AOFAS踝与后足评分为（80．1±7．4）分，与术前比较差异有统计学意义（t=27．101，P=0．000）。结论采用外侧入路经外踝截骨锁定钢板崮定行胫距跟关节融合术手术操作简单，固定强度可靠，融合率高，具有良好的临床疗效。

Objective To discuss the clinical outcome of tibiotalocalcaneal arthrodesis using lateral malleolus osteotomy amt fixation with proximal humeral internal locking system（PHILOS）. Methods From December 2008 to March 2010, 11 patients with ankle arthritis were treated by tibiotaloealcaneal arthrodesis. They were 7 men and 4 women with an average age of 48. 1 years （from 33 to 67 years）. There were 6 cases of post-traumatic arthritis. 3 cases of osteoarthritis and 2 cases of avascular necrosis of talus. The average disease duration was 2 years （from 1 to 3 years） . Three patients were complicated with ankle varus anti one patient with ankle valgus. According to the American Orthopaedic Foot ＆ Ankle Society （AOFAS） scoring sys- tem, tile preoperative ankle and hindfoot scores averaged 45.5 ± 11. 1 points（from 30 to 64 points） . Lateral malleolus osteotomy and internal fixation with PHILOS were performed in all patients. Results Superficial wound infection occurred in one patient which was cured ＇after dressing changes. The other incisions healed by first intentio,1 without complications. Ten patients were followed up for 24 months on average （front 12 to 36 months） . The X-ray films showed that bone fusion was obtained at 12 weeks postoperation （frmn 10 to 16 weeks） on average. The symptoms were relieved completely, without complications of implant failure, nonunion or malunion, in all patients at the last follow-up. The postoperative AOFAS ankle and hindfoot score at the last follow-up was 80.1 ±7.4 points, significantly higher than the preoperative one （ t = 27. 101, P = 0. 000） . Conclusion Tibiotalocalcaneal arthrodesis with lateral malleolus osteotomy and PHILOS fixation is technically simple and easy to handle, but it can provide rigid fixation and result in a high fusion rate a,ld a good clinical outcome.