全踝关节置换治疗终末期踝关节炎疗效分析

Total ankle replacement for end-stage ankle arthritis： outcome and indications

目的 探讨全踝关节置换治疗终末期踝关节炎的临床疗效.方法 回顾性分析2005年1月至2013年5月采用全踝关节置换治疗并获得随访的73例终末期踝关节炎患者资料,男34例,女39例;年龄37～76岁,平均59.6岁;身高体重指数（body mass index,BMI）21.8～ 28.0 kg/m2,平均25.3 kg/m2;均为Morrey-Wiedeman关节炎分期3期.采用美国足与踝关节协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足评分、Kofoed踝关节评分及视觉模拟评分（visual analog scale,VAS）评价术前及末次随访时患者足踝关节功能.分别以年龄55岁和术前冠状面成角10°为界分组,比较两组间AOFAS评分及踝关节活动度（range of motion,ROM）.结果 73例获得随访的患者中,除5例关节置换失败（2例衬垫断裂给予置换;2例金属假体移位或下沉,其中1例行胫距跟融合,1例翻修并融合下胫腓;1例深部感染一期取出假体二期融合）外,余68例随访时间为12～ 110个月,平均55.2个月.59例对疗效表示较满意,满意率为80.8％ （59/73）.AO-FAS踝与后足评分：术前（46.6±3.5）分,术后（86.6±4.3）分;Kofoed评分：术前（43.0±4.7）分,术后（82.6±4.6）分;VAS评分：术前（8.7±0.7）分,术后（3.0±1.0）分;ROM：术前34.4°±7.1°,术后45.1°±8.2°;各指标比较,术后较术前均明显改善.年龄55岁以下组的AOFAS评分、AOFAS功能项评分和ROM分别为（86.1±3.8）分、（47.0±2.7）分、45.7°±7.0°,55岁以上组分别为（86.7±4.6）分、（46.8±3.1）分、44.9°±8.8°;术前冠状面成角＞10°（10° ～25°）组分别为（86.1±4.7）分、（47.0±2.7）分、43.0°±7.7°,术前冠状面成角＜ 10°（-5°～7°）组分别为（86.8±4.2）分、（46.8±3.1）分、46.1°±8.2°,两组各项比较均无差异.结论 人工全踝关节置换能有效缓解疼痛,提高踝关节活动度并改善功能,是治疗部分三期踝关节炎的良好选择;术前冠状面畸形不应成为全踝关节置换的禁忌证;全踝关节置换可扩大至部分年轻患者.

Objective To explore the clinical results of total ankle replacements with the Scandinavian Total Ankle Replacement （STAR） prosthesis for end-stage ankle arthritis.Methods Data of 73 cases with end-stage ankle arthritis who received Scandinavian total ankle replacement from January 2005 to May 2013 were retrospectively analyzed.They were 34 males and 39 females,with an average age of 59.6 years old （range,37-76 years old）,average body mass index （BMI） of 25.3 kg/m2 （range,21.8-28.0 kg/m2）.All patients were classified into stage-3 arthritis according to Morrey-Wiedeman.Kofoed,American Orthopaedic Foot and Ankle Society （AOFAS） ankle and hindfoot score and visual analog scale （VAS） were used to evaluate the function of foot and ankle.Patients with a hindfoot deformity below 10° were compared with those who above 10°;and patients above 55 years old were compared with those who below it.Results 5 replacement failed （2 liner ruptured and received replacement;2 metal components displaced,1 received TTC fusion and the other underwent revision with inferior tibiofibular joint fusion,the last patient suffered from deep infection and received the STAR removal and secondary fusion） in 73,and the rest were followed up for 12 to 110 months （average,55.2 months）.59 patients were satisfied with or without reservations.The satisfaction rate was 80.8% （59/73）.The pre-op values of AOFAS,Kofoed,VAS and range of motion （ROM） were 46.6±3.5,43.0±4.7,8.7±0.7,34.4°±7.1° and the post-op values were 86.6±4.3,82.6±4.6,3.0±1.0,45.1°±8.2° respectively,and all were significantly improved compared with before.The AOFAS,AOFAS Function and ROM values of patients below 55 years old were 86.1±3.8,47.0±2.7,45.7°±7.0°,and the same values of patients above 55 were 86.7±4.6,46.8±3.1,44.9°±8.8°.The AOFAS,AOFAS Function and ROM values of patients with above 10° coronal deformity were 86.1±4.7,47.0±2.7,43.0°±7.7°,and the same values of patients below 10° were 86.8±4.2,46.8±3.1,46.1°±8.2°.There was no difference between the groups.Conclusion The STAR is the preferable surgical treatment option in patients with end-stage ankle arthritis,showing high reliability and effectivity in pain relieving and function improvement.