关节镜辅助下三钉内固定踝关节融合术治疗晚期踝关节炎疗效观察

Arthroscopic arthrodesis fixed with three screws for severe ankle arthritis

目的探讨关节镜辅助下三钉内固定踝关节融合术治疗晚期踝关节炎的临床疗效。方法 2010年4月至2014年4月,采用关节镜辅助下三钉内固定踝关节融合术治疗晚期踝关节炎患者20例。观察手术时间、踝关节的融合时间、关节融合率、术中及术后并发症,比较分析术前及末次随访时的疼痛视觉模拟评分(VAS评分)、AOFAS踝-后足功能评分。结果所有患者均获得随访,随访时间(26.3±7.4)个月。手术时间(109.4±22.6)min,均获得骨性融合,平均融合时间(10.3±2.1)周。仅1例患者发生1枚螺钉断裂,给予石膏固定后获得骨性融合。所有患者均未出现神经血管损伤、创口感染等并发症。术前及末次随访VAS评分分别为(5.80±1.67)、(1.70±1.03)分,差异有统计学意义(P=0.000)。术前及末次随访AOFAS评分分别为(54.55±7.02)、(78.95±5.59)分,差异有统计学意义(P=0.000)。结论关节镜辅助下三钉内固定踝关节融合术治疗晚期踝关节炎具有创伤小,并发症少,融合时间短,功能恢复好等优点。对于踝部无严重畸形的患者,该方法具有一定优势。

Objective To evaluate the clinical efficacy of arthroscopic arthrodesis with three screws for severe ankle arthritis. Methods Twenty patients with severe ankle arthritis were treated with arthroscopic ankle arthrodesis from April 2010 to April 2014. Data of operating time, time to fusion, rate of fusion, intraoperative and postoperative complications, VAS scores and AOFAS scores before and at last follow up were collected. Results Patients were followed up for 26.3 ± 7.4 months. All cases obtained bony fusion of the ankle with a fusion rate of 100.0%. The time to fusion was 10.3 ± 2.1 weeks. The screw was broken in one case, and bony fusion was obtained after plastered. There was no injury of nerve and vessel, no wound infection in this study. The VAS scores were decreased from 5.80 ± 1.67 before operation to 1.70 ± 1.03 at the last follow-up （P =0.000 ）. The AOFAS scores were increased from 54.55 ± 7.02 before operation to 78.95 ± 5.59 at the last follow-up （P =0.000 ）. Conclusion Arthroscopic ankle arthrodesis would be the first choice for patients with severe ankle arthritis and limited angular deformities.