经外踝截骨入路行PHILOS板内固定在踝关节融合术中的应用

The application of lateral malleolus osteotomy and internal fixation with Proximal Humerus Internal Locking System in ankle arthrodesis

目的分析经外踝截骨入路行PHILOS板内固定在踝关节融合中的手术方法和临床疗效。方法选取2010年1月至2013年12月收治的严重踝关节炎患者82例,其中男52例,女30例,平均年龄51岁（35~70岁）;左踝34例,右踝48例;合并踝关节内翻15例,外翻8例。应用美国足与踝关节协会（AOFAS）踝与后足评分和视觉模拟评分法（VAS）对术前、术后情况进行评价。结果 79例患者获得随访,随访率为96.3%。随访时间9~48个月,平均24.2个月。随访患者经X线片和CT检查证实均获得骨性融合,无畸形愈合、融合失败等并发症发生,AOFAS踝与后足评分由术前的（64.2±5.3）分提升为术后的（88.1±6.1）分,VAS评分由术前平均（6.0±0.5）分降至术后（1.0±0.2）分,术前术后差异均有统计学意义（P均〈0.05）。结论采用经外踝截骨入路PHILOS板内固定行踝关节融合,手术操作简便,固定强度可靠,融合率高,具有良好的临床疗效。

Objective To evaluate the surgical technique of lateral malleolus osteotomy and internal fixation with Proximal Humerus Internal Locking System（PHILOS） in ankle arthrodesis and its clinical effect. Methods Choose between January 2010 and December 2010 treated 82 cases of patients with severe ankle arthritis. Of the patients, 52 were males and 30 females, aged 35~70, on average 51; 34 left ankles and 48 right ankles; 15 accompanied with ankle varus deformity and 8 with valgus deformity. The AOFAS ankle and hindfoot score system and VAS score were used to evaluate and analyze the preoperative and postoperative status. Results The 79 patients（96.3%） were followed up. The follow-up was 9~48 months, on average 24.2 months. All followed-up patients showed bone fusion without complication of nonunion and malunion. The postoperative AOFAS score was（88.1± 6.1）, showing significant difference when compared with the preoperative score, which was（64.2± 5.3）. The VAS score decreased from preoperative（6±0.5） to postoperative（1±0.2） with a significant difference in statistics（all P〈0.05）. Conclusions The lateral malleolus osteotomy and internal fixation with proximal humerus internal locking system has the advantages of relatively simple technique, strong fixation, high fusion rate, and reliable clinical effect.