经外侧入路踝关节融合术治疗老年晚期踝关节炎33例的疗效分析

The treatment of geriatric ankle osteoarthritis with arthrodesis through lateral incision:efficacy of 33 cases

目的 探讨老年晚期踝关节炎的特点和评价经侧入路踝关节融合术治疗该类疾病的疗效。方法 收集完整随访的33例老年晚期踝关节炎患者的临床资料,其中男20例,女13例;年龄61-79岁,平均69.2岁。合并一种或多种慢性内科基础疾病25例（75.8%）。有踝关节创伤病史26例（78.8%）。根据Takakura-Tanaka踝关节炎分期：Ⅲa期7例,Ⅲb期12例,Ⅳ期14例。手术方法为经外踝截骨螺钉固定的踝关节融合术。统计患者的术后主观满意度,采用美国足踝外科协会（AOFAS）踝与后足评分及视觉模拟评分（VAS）评价术前及末次随访时足踝部功能。结果 33例患者随访12-49个月,平均32.4个月。31例患者为非常满意或满意,满意率为93.9%。AOFAS评分由术前的（50.90±11.99）分改善为末次随访（78.79±9.56）分,差异有统计学意义（P〈0.05）;VAS评分由术前的（6.06±1.73）分改善为末次随访的（1.72±1.13）分,差异有统计学意义（P〈0.05）。27例（81.8%）患者经CT证实完全骨性融合,4例患者部分骨性融合但达到负重要求,另外2例不融合。7例患者术后发生切口并发症。结论 老年晚期踝关节炎患者大多有陈旧性踝关节外伤病史且合并慢性内科基础疾病,经外踝截骨螺钉固定的踝关节融合术术后满意度较高,但需注意切口和骨愈合相关并发症。

Objective To evaluate the characteristics of geriatric ankle osteoarthritis and effect of arthrodesis by screw fixation through lateral malleolus osteotomy. Methods Complete follow up was gained from 33 patients （male 20, female 13） with average 69.2 years old （from 61 to 79）.25 patients （75.8 percent） were combined with more than one internal diseases.26 patients owned ankle injury history.According to Takakura-Tanaka classification,7 patients were in stage 3a,12 patients in stage 3b,14 patients in stage 4.All patients were performed with ankle arthrodesis through lateral malleolus osteotomy by screw fixation.Subjective satisfaction of patients was included in statistical analysis.The preoperative and postoperative follow up ankle function was analyzed with American orthopaedic foot and ankle society （AOFAS） Ankle Hindfoot Score and Visual analogue scale （VAS）. Results The average follow up of 33 patients was 32.4 months （From 12 to 49 ）.The satisfaction rate in 31 patients was 93.9 percent.The AOFAS score in last follow up was significantly improved to （78.79 ±9.56）,compared with preoperative （50.90 ±11.99）,P〈0.05.The VAS score in last follow up was significantly decreased to （1.72 ± 1.13）,compared with preoperative （6.06 ± 1.73）,P〈0.05.Seven patients were accompanied with incision complications. 27 patients（81.8 percent） reached complete solid fusion,which was confirmed by CT.4 patients was partially bony fused,which could also perform weight-bearing walk,2 patients were not bony fused. Conclusion Geriatric ankle osteoarthritis was usually combined with ankle injury history and internal disease. It could reach high satisfaction rate with ankle arthrodesis by screw fixation through lateral malleolus osteotomy.Ineision and bony healing complications should draw attention.