人工踝关节置换74例并发症防范

Prevention of complications in 74 total ankle replacement

[目的]探讨人工踝关节置换的并发症防范。[方法]自1998年10月～2011年12月,人工踝关节置换治疗踝关节损伤性关节炎、类风湿性关节炎74例(其中伴距骨体顶部局限性坏死2例和胫骨骨折并小腿筋膜间室综合征广泛肌切除后距下关节融合1例)。男49例,女25例;平均56.8岁(28～68岁)。[结果]本组74例获平均8年10个月随访(2年10月～13年8月)。术前、术后踝关节功能采用Kofoed评价法和步态分析,术前踝关节功能63分(61～74分)13例,47分(30～60分)43例,16分(0～29分)18例。术后效果优(85～100分)39例,良(75～84分)32例,可(60～74分)2例,差(59分以下)1例。优良率95.9%。术前、术后疗效按Kofoed评价以统计学分析,P<0.01具有显著意义。术前步态49例均为跛行步态(负重相>55%);术后正常步态(15%～45%周期内)24例,轻微跛行(站立相45%～55%)22例,跛行(负重相>55%)3例。术前、术后步态分析两组数据的统计学分析P<0.01,有统计学显著意义。X线检查显示植骨部与假体间固定良好,植骨成活。[结论]规范施术、植骨和早期负重等,是防范并发症的重要环节。

[ Objective] To study the prevention of complications in total ankle replacement. [ Method] Since October, 1998 to December,2011 ,total ankle replacement with autografing was emplayed to treat 73 cases of traumatic osteoarthritis and one rheumatoid （among two local necrosis of the talus, and one occurred after ankle and snbtalar joint arthrodesis for tibial fracture and osteofascial compartment syndrome）. They were 49 men and 25 women. Their ages ranged from 28 to 68 years, averaging 56.8 years. [ Result ] In this group,74 patiens were followed up for a mean time of 8 years and I0 months （3 years and 5 months to 13 years and 8 months）. The ankle function was evaluated by Kofoed＇s system and gait analysis system in pre- and post-opera- tion. In preoperation,the ankle function score were mean 63 points（61 -74）in 13 cases,47 points（30 -60）in 43,16 points（0 - 29） in 18 cases. The score of postoperation were excellent （ 85 - 100） in 39 patients, good （ 75 - 84） in 32, fair （ 60 - 74） in 2 cases,poor（ 〈59）in one. The overall excellent and good results rate was 95.9%. The score of the ankle function at post-opera- tion compared with pre-operation showed significant differences in this group（P 〈0.01 ）. Forty-nine cases in gait analysis scan- ning system at pre-operation were lame（in standing phase 〉 55% ）. But normal gait（ in phase 15% -45% ）were in 24 cases, light-lame（ standing phase 45% - 55% ） in 22 cases, and lame gait （ stand phase 〉 55% ） in 3 cases during post-operation. It were found better in the post-operative gait than in the pre-operative （P 〈 0. 05 ）. The X-ray films showed that fixation was strong,and autograft survived well. [ Conclusion] The standard operation, autografting and loading early are the key links for prevention of complication in total ankle replacement.