经前外侧距骨双螺纹加压钉行踝关节融合术

Clinical application of I.CO.S screw for ankle arthrodesis through anterolateral approach

背景：当前在中国，踝关节融合术作为治疗终末期踝关节炎和病损给患者带来的长久功能和利益来讲，仍然是一个现实可行的手术方法或“金标准”，但术式众多和融合率结果参差不齐，融合术后功能评价及结果亦不知晓。目的：介绍经前外侧骨双螺纹加压钉（I．CO．S）行踝关节融合术的方法与临床效果。方法：2006年1月至2009年12月，利用I．CO．S对24例踝关节严重病损患者行踝关节融合术。男15例，女9例；年龄23-68岁，平均45岁；严重创伤后关节炎和（或）距骨体部分坏死患者16例，踝关节骨关节炎8例。所有患者均进行临床和影像学评估，手术均采用踝关节外侧入路，腓骨下段截骨，利用摆锯截骨，在距骨颈基底部跖侧和距骨外侧突双螺纹空心钉（I．CO．S）3n压固定，术后石膏支具固定直至融合。结果：所有患者均获得随访，平均随访时间22个月（14—64个月）。术后2周切口I期愈合，4周可见骨痂形成，12周患者疼痛明显缓解或消失、足部外形改善。X线片及CT示胫距关节牢固融合。所有患者术后踝关节僵硬但没有并发症出现，按美国足踝外科协会（AOFAS）后足评分系统进行疗效评估，19例优，3例良，2例可。结论：采用2枚经距骨双螺纹加压钉（I．CO．S）行踝关节融合的手术方法简单可靠，融合率高。其优点为切口显露良好，对胫距关节干扰小，再次植骨，外踝旁靠植骨提高了植骨强度。

Background： Ankle arthrodesis is a golden standard for the management of terminal stage ankle arthritis and impairment in China. However, the surgical procedures are many and varied. Functional assessment and clinical outcomes of these meth- ods are not well defined. Objective： The aim of the study is to introduce a new technique of ankle arthrodesis with I.CO.S screw （Ideal Compression Screw Surgical Technique） through anterolateral approach and evaluate its clinical outcomes. Methods： Between January 2006 and December 2009, 24 patients with severe ankle impairment underwent arthrodesis with I.CO.S screw. There were 15 males and 9 females with an average age of 45 years （range, 23 to 68 years）. Of them, 16 pa- tients suffered from post-traumatic arthritis and/or avascular necrosis （PAVN） of talus and 8 had ankle osteoarthritis. Lateral incision was adopted for osteotomy of fibula. Proper cast was utilized postoperatively to maintain a functional position. All the patients were assessed clinically and radiologically during the follow-up. Results： All the patients were followed up for 14 to 64 months （mean 22 months）. All the operative incisions healed well at 2 weeks and the callus appeared 4 weeks postoperatively. Sufficient pain relief was obtained in all patients at 12 weeks and appearance improved greatly. A solid union was achieved in all cases through X-ray and CT scan. All patients had ankylosis but no complications related to the surgery. According to the American Orthopaedic Foot and Ankle Society （AOFAS） An- kle-Hindfoot score, we found that 19 patients got excellent results, three had good, and two showed fair results. Conclusions： The use of I.CO.S screw in ankle arthrodesis by anterolateral approach is proved to be a simple technique with high fusion rate. The main advantages of the technique over other methods of arthrodesis include excellent exposure by reg- ular incision, no need for extra graft through in situ grafting of the bone blocks and rigid on lay grafting of lateral malleolus for high primary stability.