胫距跟关节融合术中应用逆行髓内钉或锁定钢板固定的疗效比较

Comparison of retrograde intramedullary nailing versus locking plating for tibiotalocalcaneal arthrodesis

目的比较胫距跟关节融合时应用逆行髓内钉固定与锁定钢板固定的疗效。方法回顾性分析2012年1月至2017年1月华中科技大学同济医学院附属普爱医院骨科行胫距跟关节融合治疗的47例患者资料,其中行逆行髓内钉内固定术者28例(髓内钉组),锁定钢板内固定术者19例(钢板组)。统计比较两种固定方法的关节骨性融合率、骨性融合时间、返修率、手术相关并发症、美国足踝外科学会(AOFAS)的踝-后足评分和简明健康调查问卷(SF-36)评分。结果47例患者的骨性融合率为80.9%(38/47),髓内钉组(71.4%)低于钢板组(94.7%),差异有统计学意义(P<0.05);两组骨性融合时间分别为(5.0±0.9)个月和(5.5±1.1)个月,骨性不融合症状明显需返修率分别为17.8%(5/28)和5.2%(1/19),AOFAS踝-后足评分分别为(80.6±8.4)分和(79.5±5.7)分,SF-36评分分别为(78.9±7.1)分和(88.9±7.7)分,以上比较两组间差异均元统计学意义(P>0.05)。钢板组并发症发生率(47.4%)较髓内钉组(17.9%)高,差异有统计学意义(P<0.05),两组均有伤口愈合不良、内固定激惹、神经损伤并发症存在。结论在胫距跟关节融合中应用逆行髓内钉固定与锁定钢板固定均可获得良好疗效,锁定钢板固定较逆行髓内钉具有更高的融合率,但是并发症发生率也随之升高。

Objective To compare the curative effects of retrograde intramedullary nailing versus locking plating for tibiotalocalcaneal arthrodesis.Methods A retrospective study was performed of the 47 patients who had undergone tibiotalocalcaneal arthrodesis from January 2012 through January 2017 at Department of Orthopaedics,Pu'Ai Hospital.Of them,28 were treated by retrograde intramedullary nailing and 19 by locking plating.The 2ways of fixation were compared in terms of bony union rate,bony union time, revision rate,complications,American Orthopaedic Foot and Ankle Society (AOFAS)Ankle-Hindfoot Scale and Short Form 36(SF-36)scores.Results The overall bony union rate was 80.9%(38/47)for the 47patients;the bony union rate for the intramedullary nailing group (71.4%)was significantly lower than that for the locking plating group (94.7%)(P <0.05).There were no significant differences between the 2 groups in revision rate due to nonunion [17.8%(5/28)versus 5.2%(1/19)],bony union time (5.0±0.9 months versus 5.5±1.1months),AOFAS Ankle-Hindfoot Scale (80.6±8.4points versus 79.5±5.7 points)or SF-36 scores (78.9±7.1 points versus 88.9±7.7points)(P >0.05).The locking plating group had a significantly higher incidence of wound complications (47.4%)than the intramedullary nailing group (17.9%)(P <0.05),but there were no significant differences between the 2 groups in symptomatic hardware or nerve irritations.Conclusions Both retrograde intramedullary nailing and locking plating can lead to fine curative effects in tibiotaloealcaneal arthrodesis.Although locking plating may result in a higher union rate than retrograde intramedullary nailing,it may cause a higher rate of wound complications.