关节镜治疗踝关节骨关节炎的临床结果及预后因素分析

Clinical Outcomes and Prognostic Factors of Arthroscopic Treatment for Ankle Osteoarthritis

目的：评估关节镜治疗踝关节骨关节炎的临床疗效,分析与临床结果相关的预后因素。方法：观察2010年3月―2012年3月我院经关节镜治疗的34例踝关节骨关节炎患者,使用视觉模拟评分（Visual Analogue Scale,VAS）、美国足踝外科协会踝与后足评分（American Orthopaedic Footand Ankle Society,AOFAS）和关节活动度（Range of Motion,ROM）进行临床结果评测,使用logistic回归分析验证预后因素和临床结果的关系。结果：所有患者均获临床随访,随访时间1~24个月,平均（14.37±4.51）个月,VAS和AOFAS评分最大改善平均为术后（4.6±1.3）个月。术后24月VAS评分平均为（4.3±1.2）分,与术前（7.4±1.2）分比较,差异有统计学意义;AOFAS评分,术后24月随访时平均为（78.4±7.6）分,与术前（41.3±11.6）分比较,差异有统计学意义;ROM由术前的（26±5.8）°改善为（31.8±9.5）°.AOFAS评分：优25例,良5例,中3例,差1例,优良率88.2%.踝关节损伤、职业类别及X线分级与临床结果有显著性相关,年龄、性别、病程与临床结果无显著性相关。结论：关节镜是治疗踝关节骨关节炎的良好选择,能够阻止或延缓病情的进一步发展,有效减轻疼痛症状,改善踝关节的功能。踝关节损伤、职业类别及X线分级是预后不良的重要危险因素。

Objective：To evaluated the clinical efficacy of patients who have undergone arthroscopic treatment for ankle osteoarthritis and to analyze the prognostic factors associated with clinical outcome.Methods：Retrospective analyzed about34patients（from March 2010 to March 2012）with ankle osteoarthritis who underwent arthroscopic treatment.The visual analogue scale（VAS）,the ankle and hindfoot score of American orthopedic foot and ankle society（AOFAS）,and the range of motion（ROM）were used to analyze the efficacy.The relationship between prognostic factors and clinical outcomes were analyzed by the logistic regression analysis of SPSS（version 19.0）.Results：All 34 patients were followed up from 1to 24months（14.37± 4.51 months averagely）,the VAS and AOFAS scores were improved largest at 4.6±1.3months after surgery.The VAS,AOFAS and ROM were significantly improved from 7.4±1.2,41.3±11.6,26±5.8°to 4.3±1.2,78.4±7.6,31.8±9.5°respectively at the postoperative.According to the AOFAS score,25 cases in excellent,5in good,3in fair,1in poor,and clinical excellent or good rate was 88.2%.The age,gender and symptom duration did not show a significant association with the clinical outcomes.However,the patients with ankle joint injury and professional category showed a significant correlation with the clinical outcome.Conclusion：Arthroscope is a good option for treating ankle osteoarthritis.It can prevent or delay the further development of the illness,alleviate pain symptoms effectively,and improve the function of the ankle.Ankle injury and occupational categories is an important risk factor for poor prognosis.