创伤性踝关节炎:人工踝关节置换术与踝关节融合术的早期疗效对比

Treatment of post-traumatic ankle arthritis: arthrodesis versus total ankle replacement in early-stage outcome

目的 对在创伤性踝关节炎的手术治疗中,传统的踝关节融合术与踝关节置换术这两种手术方式的早期疗效进行对比研究。方法 回顾性研究收集自2009年3月-2014年10月在我院因创伤性踝关节炎行手术治疗的患者55例（56踝）,平均年龄为51.2岁,平均随访35.3（3~68）个月。分别将采用人工全踝关节置换术、踝关节融合外支架固定术、踝关节融合内固定术的患者分为3组,其中行人工踝关节置换术的患者14例（14踝）,平均随访35.4（7~67）个月;行踝关节融合外支架固定术的患者18例（19踝）,平均随访31.2（3~68）个月;行踝关节融合内固定组的患者23例（23踝）,平均随访38.8（10~58）个月;对3组患者分别在术前、术后使用美国骨科足踝协会后足评分（AOFAS）、SF-36评分、关节活动度（ROM）进行分析评价,对术后并发症进行统计分析,比较踝关节置换术与融合术的早期疗效。结果 55例患者均获得随访,踝关节置换术组术后AOFAS评分为72.92±5.42,SF-36评分为79.42±4.23,踝关节融合组（外支架固定）术后AOFAS评分为69.36±3.21,SF-36评分为67.78±4.51,踝关节融合（内固定）术后AOFAS评分为67.41±6.49,SF-36评分为72.86±6.37,3组均较术前评分有明显改善（P〈0.05）,且踝关节置换组在术后各评分较融合组高,踝关节置换组术后踝关节活动度为（32.1±4.7）°较术前明显改善。随访3组并发症的发生分别为2例、4例（外固定组）、3例（内固定组）,早期并发症发生率差异没有统计学意义（P〉0.05）。结论 在创伤性关节炎的手术治疗中,人工踝关节置换术较踝关节融合术在早期内对病患的生活质量改善更明显,没有增加相应的术后并发症。

Objective To compare the early-stage outcome of total ankle replacement and ankle arthrodesis in the treatment of post-traumatic ankle arthritis. Methods A retrospective analysis was carried on 55 patients （56 ankles） with post-traumatic ankle arthritis receiving surgical treatment in our department from March 2009 to October 2014. They were at a mean age of 51.2 years, and were followed up for an average duration of 35.3 months （3 to 68 months）. The cohort were divided into 3 groups, that is, total ankle replacement group [ n = 14, followed up for 7 to 76 months （ mean 35.4 months） ] , arthrodesis with external fixation support group [n = 19, followed up for 3 to 68 months （mean 31.2 months）], and arthrodesis with internal fixation group [ n =23, followed up for 10 to 58 months （mean 38.8 months） ]. The early-stage ankle functions were assessed preoperatively and postoperatively by American Orthopaedic Foot ＆ Ankle Society （AOFAS） scores and 36-item Short-form （SF-36） Health Survey. Range of motion （ROM） were alsomeasured before and after treatment. Results All the patients were followed up. In the ankle replacement group, their average AOFAS score was 72.92 ± 5.42 and the SF-36 score was 79.42 ± 4.23. In the ankle arthrodcsis with external fixation group, the average AOFAS score was 69.36 ±3.21, and the SF-36 score was 67.78±4.51. While for the ankle arthrodesis with internal fixation group, the scores were 67.41 ±6.49 and 72.86 ± 6.37, respectively. The scores were obviously increased in all the 3 groups as compared with those before operation （ P 〈 0. 05 ）. The ankle replacement group obtained significantly higher score than the other 2 group, and had its average ROM of 32.1° ± 4.7°, remarkably improve than before operation. The incidences of complications were 2, 4 and 3 cases respectively for the ankle replacement group, and the ankle arthrodesis with external and internal fixation group, though no significant differences among them （ P 〉 0. 05 ）. Conclusion In the treatment of post-traumatic ankle arthritis, total ankle replacement shows better improvement in patients＇ quality of life , and does not increase then incidences of corresponding postoperative complications than ankle arthrodesis in early-stage outcome.