距下关节融合术对踝关节功能的影响

Evaluation of ankle joint function after subtalar arthrodesis

目的 评价单纯距下关节融合术的治疗效果,分析距下关节融合对踝关节功能的影响.方法 回顾性研究1996年1月至2011年8月期间接受距下关节融合术的患者,采用36项简易健康问卷（SF-36）和美国足踝骨科学会（AOFAS）踝与后足功能评分评价患者症状.摄踝关节负重位X线片,观察有无关节退变,分析踝关节矢状面和冠状面活动度,评估踝关节功能.采用t检验和Pearson相关分析等方法进行数据比较及相关性分析.结果 成功随访患者37例,其中男27例,女10例,平均年龄42.6岁（13-74岁）,平均随访时间为9.2年（2-17年）;SF-36评分总分由术前34.26±11.02分提高至术后末次随访时77.59±12.57分,术后患者SF-36评分显著提高（P＜0.01）;AOFAS踝与后足评分由术前50.32±12.39分提高至术后末次随访时73.14±15.44分,术后AOFAS评分显著改善（P＜0.01）;34例患者术后出现踝关节背伸跖屈受限,平均受限45.6％,这与距骨倾斜角减小、后足高度降低、踝关节退变等因素有关;所有患者踝关节内外侧稳定性好,无内外翻代偿活动.结论 距下关节融合术是治疗距下关节病变的有效方法,但对踝关节功能确实有影响.术后91.9％患者跖屈背伸活动明显受限,13.5％患者X线片上可见踝关节轻度退变,踝关节内外侧稳定性变化小,未出现代偿性内外翻活动.

Objective To evaluate the postoperative efficacy and to analysis the changes of ankle joint function of patients with isolated subtalar arthrodesis.Methods The data of patients who were treated by subtalar arthrodesis between January1996and August 2011 was retrospectively analyzed.According to the 36-item short-form(SF-36)health survey and American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,the symptoms were assessed.To evaluate ankle function,bilateral ankle activities on sagittal and coronal planes were analyzed and ankle degeneration signs on weight-bearing X-rays were observed.The obtained data were analyzed with t-test and Pearson linear correlation.Results Thirty-seven patients(27 males,10females)with an average age of 42.6(range,13to74)years were followed up.The average follow up period was 9.2(range,2to 17)years.The average of SF-36 score had increased from34.26±11.02 preoperatively to 77.59±12.57 postoperatively(P<0.01).The average of AOFAS ankle-hindfoot score had increased from50.32±12.39 preoperatively to 73.14±15.44postoperatively with statistical significance(P<0.01).Dorsiflexional and plantarflexional ankleactivities of 34 patients got obviously limited to 45.6%,which were related to decreased talar inclination,reduced hindfoot height and ankle degeneration.Both medial and lateral stability of the ankle joint stayed good after subtalar fusion,and there was no much compensatory activity on coronal plane.Conclusions Subtalar arthrodesis is indeed an effective procedure to treat subtalar diseases,although it changed ankle joint function to some extent.Postoperatively91.9%patients got ankle motion limited significantly,but the ankle joint had no obvious compensatory varus or valgus activities after subtalar fusion and its medial and lateral stability stayed fine.