关节镜辅助Ilizarov牵张技术治疗踝关节创伤性骨关节炎疗效观察

EFFECTIVENESS OF DISTRACTION THERAPY ASSISTED BY ARTHROSCOPE IN TREATMENT OF ANKLE TRAUMATIC OSTEOARTHRITIS

目的探讨关节镜辅助Ilizarov牵张技术治疗踝关节创伤性骨关节炎的疗效。方法 2013年10月-2014年10月,收治踝关节创伤性骨关节炎患者13例。男8例,女5例;年龄44~63岁,平均55.2岁。左踝4例,右踝9例。病程1.5~10.0年,中位病程5年。踝关节活动受限。美国矫形足踝协会（AOFAS）踝-后足评分系统评分为（51.00±7.09）分。简明健康调查量表（SF-36量表）评分为（40.82±4.62）分。骨关节炎根据Scranton分级标准,Ⅱ级9例,Ⅲ级4例。首先经关节镜清除增生骨赘,然后采用Ilizarov外固定架牵伸至踝关节间隙为5~10 mm后,维持固定3个月。结果术后1例拆除Ilizarov外固定架后并发针孔感染,经换药后愈合;其余患者均无感染等相关并发症发生。患者均获随访,随访时间12~18个月,平均14.7个月。术后患者踝关节肿胀消失,疼痛症状缓解,均能正常行走。踝关节活动度均有明显改善。末次随访时,AOFAS踝-后足系统评分为（85.23±6.41）分,SF-36量表评分为（56.29±6.20）分,均较术前显著提高（t=20.756,P=0.025;t=11.647,P=0.018）。根据AOFAS评分,获优4例,良8例,可1例,优良率92.3%。X线片复查示：踝关节位置、形态正常,胫骨、距骨边缘骨质增生,关节面硬化,关节间隙正常,关节无肿胀。结论关节镜辅助Ilizarov牵张技术是治疗踝关节创伤性骨关节炎的一种有效方法。

Objective To investigate the effectiveness of distraction therapy assisted by arthroscope in the treatment of ankle traumatic osteoarthritis. Methods Between October 2013 and October 2014, 13 patients with ankle traumatic osteoarthritis were treated, including 8 males and 5 females with an age range of 44-63 years（mean, 55.2 years）. The left ankle and the right ankle were involved in 4 and 9 cases respectively. The disease duration was 1.5-10.0 years（median, 5 years）. The American Orthopaedic Foot and Ankle Society（AOFAS） ankle-hind foot scale score was 51.00±7.09; the short-form 36 health survey scale（SF-36） score was 40.82±4.62. According to Scranton grade system, 9 cases were rated as grade II and 4 cases as grade III. First, ankle hyperplasia osteophytes was removed under arthroscope, then Ilizarov apparatus was used to maintain distraction of 5-10 mm ankle space for 3 months. Results One case had postoperative pin tract infection after removing the external fixation, and infection was controlled by dressing treatment; no related complications occurred in the other patients. All patients got follow-up of 12-18 months（mean, 14.7 months）. Patients achieved disappearance of ankle swelling, pain relief, and were able to walk after rehabilitation. The ankle activity was obviously improved. At last follow-up, AOFAS ankel-hind foot scale score and SF-36 score were significantly increased to 85.23±6.41 and 56.29±6.20 respectively（t=20.756, P=0.025; t=11.647, P=0.018）. According to AOFAS scores, the results were excellent in 4 cases, good in 8 cases, and fair in 1 case; the excellent and good rate was 92.3%. Postoperative X-ray film showed normal ankle position and alignment, osteophytes at the edges of the tibia and talus, articular surface sclerosis, normal joint space, and no joint swelling. Conclusion Distraction therapy assisted by arthroscope is an effective method for treating ankle traumatic osteoarthritis.