Ilizarov支架外固定联合踝关节融合术治疗终末期踝关节炎

Arthrodesis of ankle joint by Ilizarov external fixator in patients with end-stage ankle arthritis

目的探讨采用Ilizarov支架外固定联合踝关节融合术治疗终末期踝关节炎的疗效。方法回顾性分析自2013-06—2014-12采用Ilizarov支架外固定联合踝关节融合术治疗的13例终末期踝关节炎。末次随访时摄踝关节正侧位X线片,必要时CT三维重建检查,确定是否达到骨性融合。采用AOFAS评分标准评价踝关节功能。结果本组13例均获得随访10~28个月,平均17个月。术后均骨性融合,骨愈合时间12~18周,平均15周。外固定架拆除时间16~22周,平均20周。3例出现针道并发症,反复使用酒精及百多邦外用后控制;其中1例针道感染流脓,反复换药经久不愈,更换克氏针后愈合。末次随访时踝关节功能按AOFAS评分标准评定:优1例,良9例,可3例。末次随访时AOFAS评分为69~91(79.6±7.2)分,明显高于术前,差异有统计学意义(t=37.450,P<0.001)。结论采用Ilizarov支架外固定联合踝关节融合术治疗终末期踝关节炎的骨愈合率高,尤其适用合并感染、软组织条件差、骨质缺损严重及踝关节畸形的患者。

Objective To assess the results of the Ilizarov external fixator in ankle fusion for patients with end-stage ankle arthritis.Methods Between June 2013 and December 2014,13 patients with end-stage ankle joint arthritis were treated by ankle arthrodesis using the Ilizarov external fixator.The results of ankle arthrodesis were evaluated according to whether there was pain and activity of fusion ankle,whether the patient could walk bearing weight,and X-ray signs and 3D CT reconstruction when necessary.Ankle function was evaluated according to AOFAS ankle-hindfoot scale.Results All patients were followed up for 10 to 28 months （17 months in average）.All patients achieved sound fusion in 12 to 18 weeks （15 weeks in average） and the Ilizarov external fixator was dismantled in 16 to 22 weeks （20 weeks in average）.Three cases had needle complications such as redness,swelling,pain,discharge and were cured by using alcohol and Mupirocin ointment（Bactroban）.Among them 1 case had needle infection and pus discharging and could not be cured by dressing changing,the Kishner wire was finally replaced and the wound was healed.Ankle function was evaluated according to AOFAS ankle-hindfoot scale at the time of the last follow-up,1 patient was rated as excellent,9 as good,3 as fair and none as poor.The mean AOFAS score was 69-91（79.6±7.2）,which was much better than preoperative score,and this difference was statistically significance（t =37.450,P 〈0.001）.Conclusion Ilizarov technique can lead to a high rate of bony fusion of the ankle joint,and is especially suitable for that with combined ankle infection and poor soft tissue condition.