踝关节骨性关节炎的治疗

The treatment of osteoarthritis of the ankle joint

踝关节作为主要的承重关节,其骨性关节炎的发病率并不低。踝关节骨性关节炎可表现为疼痛和功能受限,严重影响患者的生活质量。对于不同病理阶段的踝关节骨性关节炎,处理方法也不尽相同。早期的骨关节炎可以采取保守治疗,如非甾体抗炎药、理疗、支具、关节腔内注射、冲击波等。冲击波、关节腔内注射透明质酸钠、富血小板血浆等疗法已显示了短期内的良好效果,而关节腔内注射皮质类固醇则多用于类风湿和痛风患者。非手术治疗无效,关节功能受限,症状加重时,可考虑行手术治疗,首选关节镜清理、外固定架牵张、自体骨软骨移植、组织工程技术及踝上截骨等方法。对于终末期踝关节骨性关节炎,踝关节融合术及全踝关节置换术各有优缺点,临床工作中需权衡选择。

The ankle joint is the main weight-bearing joint,and the incidence of osteoarthritis is not low.Osteoarthritis of the ankle can be characterized by pain and functional limitation,which seriously affects the quality of life of patients.For different stages of pathology,the treatment of osteoarthritis of the ankle is different.Early osteoarthritis can be treated conservatively,such as nonsteroidal anti-inflammatory drugs,physiotherapy,brace,intra-articular injection,shock wave and so on.Shock wave,intraarticular injection of sodium hyaluronate,platelet rich plasma and other therapies showed good results in short-term follow-up,while intra-articular injection of corticosteroids is often used in patients with rheumatoid and gout.If non-surgical treatment is ineffective,joint function is limited,and when the symptoms are aggravated,surgical treatment can be considered.Arthroscopy,external fixation,autologous osteochondral transplantation,tissue engineering techniques,and supramalleolar osteotomy are prefered.For end-stage osteoarthritis of the ankle joint,ankle arthrodesis and total ankle arthroplasty have their own advantages and disadvantages,we need to choose the suitable way in clinical work.