截骨术在不对称踝关节关节炎治疗中的应用

Application of osteotomy in the treatment of asymmetric ankle arthritis

目的探讨截骨术在不对称踝关节关节炎治疗中的应用效果。方法对36例不对称踝关节关节炎患者行踝关节截骨术。其中,行单纯踝上胫骨截骨术10例,上胫腓骨截骨术6例,踝上胫骨截骨合并跟骨截骨术18例,踝上胫腓骨截骨合并跟骨截骨术2例。观察术后3、6个月的胫骨前面角(TAS)、胫骨侧面角(TLS)以及术后6、12个月AOFAS评分和ADL评分。观察术后并发症情况。结果患者均获得随访,时间13～17个月。骨性愈合时间为56～81(68. 22±12. 07) d。与术前比较,术后3、6个月TAS、TLS显著增加(P <0. 05);与术后3个月比较,术后6个月TAS、TLS显著增加(P <0. 05)。与术前比较,术后6、12个月AOFAS评分显著升高(P <0. 05),ADL评分显著降低(P <0. 05);与术后6个月比较,术后12个月AOFAS评分显著升高(P <0. 05),ADL评分显著降低(P <0. 05)。切口延迟愈合2例(5. 56%),经常规伤口护理后愈合;轻度内外翻2例(5. 56%),活动受限1例(2. 78%);无螺钉松动、断裂及内固定失效等其他并发症发生。结论踝关节截骨术治疗不对称踝关节关节炎疗效显著,并发症少,能够减轻病变处关节软骨的负荷,促进踝关节功能恢复。

Objective To investigate the application effect of osteotomy in the treatment of asymmetric ankle arthritis. Methods Ankle osteotomy was performed in 36 patients with asymmetrical ankle joint osteoarthritis. Among them, 10 cases were treated with only supracondylar tibial osteotomy, 6 cases with upper tibiofibular osteotomy, 18 cases with supracondylar tibial osteotomy, 2 cases with osteotomy of upper tibiofibular osteotomy and tibial osteotomy. Thetibial anterior surface angle （TAS） and the tibial lateral surface angle （TLS） were compared at 3,6 months after operation, and the AOFAS score and ADL score were compared in 6,12 months after the operation. The postoperative complications were observed. Results All patients were followed up for 13~17 months. The bony union time was 56~ 81（68.22±12.07） d. Compared with the preoperative, TAS and TLS were significantly increased in 3, 6 months after operation （ P〈 0.05）; compared with 3 months after operation, the TAS and the TLS were increased significantly at 6 months postoperation （ P〈 0.05）. Compared with the preoperative, the AOFAS score in 6,12 months after operation was significantly increased（ P〈 0.05）, and the ADL score was significantly decreased （ P〈 0.05）; compared with the 6 months after operation, the AOFAS score was increased significantly （ P〈 0.05）, and the ADL score was decreased significantly at 12 months postoperation（ P〈 0.05） . There were 2 cases （5.56%） with delayed union, and healed after the conventional treatment; 2 cases （5.56%） with mild ankle joint of inversion or eversion,and 1 case （2.78%） with limited motion; there were no complications such as screw loosening, fracture and internal fixation failure. Conclusions The treatment of ankle joint osteoarthritis with ankle joint osteotomy is effective with less complication. It can relieve the load of articular cartilage and promote the recovery of ankle joint function.