踝关节融合术后患足功能研究

The function of foot after open ankle arthrodesis

目的探讨踝关节融合术后患足的功能状况及其对终末期踝关节骨关节炎患者日常生活的影响。方法回顾分析2012年12月至2017年8月在北京积水潭医院行单侧踝关节切开融合术的20例终末期踝关节骨关节炎患者的病历资料。其中男13例,女7例,年龄49. 4岁(27～67岁)。手术前后采用美国足踝外科协会踝-后足功能评分标准(AOFAS)及视觉模拟评分法(VAS)评估患足的功能,并询问患者术后上下楼梯、上下坡以及在不平路面行走的适应情况。记录最远行走距离和最长行走时间,评估手术对患者自身职业及休闲娱乐活动的影响。术后每个月复查X线评估踝关节愈合情况,术后8～12周复查CT评估踝关节骨性愈合情况及患足负重情况。末次随访时,询问患者是否愿意重新调整踝关节融合的位置,以及改变方向。观察并记录患者的伤口愈合时间、神经损伤情况及骨折不愈合等发生情况。结果平均随访时间为30. 2个月。手术前后平均AOFAS评分分别为45. 4分和79. 8分,平均VAS评分分别为6. 8分和0. 7分。多数患者上楼梯、下坡相对较好,下楼梯、上坡、下蹲、快走等相对较差。平均最远行走距离为1 700 m,14例患者独立行走时间超过60 min。术后6例患者未再工作或退休,13例继续从事原来的职业,1例难以继续从事原来的职业。术前进行休闲娱乐活动的15例患者中,12例自觉关节融合对于休闲娱乐活动有明显的影响。末次随访时,6例患者希望不同程度地增加踝关节融合背伸的角度。其中不愈合1例,愈合率为95%(19/20),平均愈合时间为13. 4周。20例患者中15例踝关节完全无痛,其余5例疼痛有不同程度的缓解。结论踝关节切开融合术后患足的功能令人满意,但对于休闲娱乐活动有较大不良影响。而且术中需注意关节面的处理及融合位置的确定。

Objective To investigate the clinical results and the daily life activities of patients suffering end-stage ankle osteoarthritis after open ankle arthrodesis. Methods Clinical data of 20 patients underwent unilateral open ankle arthrodesis in Beijing Jishuitan Hospital fi＇om December 2012 to August 2017 were retrospectively analyzed. There were 13 males and 7 females with an average age of 49.4 years （27-67 years）. The function of the ankle was assessed by the American Orthopaedic Foot and Ankle Society- （AOFAS） and visual analogue scale （VAS） before and after the operation, and the adaptation situation of the patient going up- stair and down-stair, up and down slopes and uneven roads in daily life were asked. The longest walking distance and longest walking time were recorded, and the impact of the operation on the patient＇ s own occupation and leisure activities were evaluated . The ankle joint healing was evaluated by X-ray evenly month after operation. The bone healing and the weight bearing of the ankle joint were evaluated by CT at 8-12 weeks postsperatively. At the last follow-up, the patients were questioned if they would like to re-adjust the position and direction of the ankle joint. The wound healing time, nerve damage and fi＇acture non-healing were observed and recorded. Results The average follow up time was 30.2 months. The average AOFAS scores before and after surgery were 45.4 and 79.8, and the average VAS scores were 6.8 and 0.7, respectively. The going upstair and down-slope were relatively good, however down-stair, up-slope, squatting and brisk walking were relatively poor in most patients. The average longest walking distance was 1 700 m, and 14 patients walked independently for more than 60 nfin. Six patients retired or did not work after surgery, 13 patients could return to their previous jobs, and one patient was difficult to continue with his current occupation. Of the 15 patients engaged in recreational activities before surgery, 12 patients of conscious joint fusion had a significant impact on recreational activities after surgery. At the last follow-up, 6 patients wished to increase the angle of ankle joint fusion extension to varying degrees. One ease did not heal, the healing rate was 95% （19/20）, and the average healing time was 13.4 weeks. The pain was completely relieved in 15 eases, and was partially reliefed in the remaining 5 eases. Conclusion The function of the ankle after open ankle arthrodesis was satisfactory. The arthrodesis has linfited effect on daily life aetiviies, and has a great negative impact on recreation activity. More attention should be paid to the treatment of the articular surface and the determination of the fusion position during the operation.