关节镜下应用双平行无头加压螺钉行踝关节融合术治疗踝关节炎的疗效分析

Therapeutic effect of arthroscopic anlcle arthrodesis using double-parallel headless compression screw for the treatment of ankle arthritis

目的探讨关节镜下应用双平行无头加压螺钉行踝关节融合术(arthroscopic ankle arthrodesis, AAA)治疗踝关节炎的疗效。方法研究共纳入2016年3月至2017年9月期间于我院骨关节科接受关节镜下应用双平行无头加压螺钉行踝关节融合术(微创组)的16例踝关节炎病人及行开放踝关节融合术(开放组)的12例病人。评估并比较2组病人术后3个月及1年的骨性融合率和美国足踝外科医师协会(AOFAS)踝与后足功能评分。结果术后3个月时,微创组的骨性融合率为93.8%(15/16),高于开放组的66.7%(8/12),差异有统计学意义(χ2=5.328, P= 0.013);术后1年时2组病人全部达到骨性融合。术后3个月,微创组的AOFAS评分为(65.3±2.7)分,开放组为(53.8±2.1)分,差异有统计学意义( t= 1.839, P<0.05);术后1年时,微创组的AOFAS评分为(75.3±2.7)分,明显高于开放组的(68.8±2.5)分,差异有统计学意义( t = 7.526, P<0.01)。 结论关节镜下应用双平行无头加压螺钉行踝关节融合术早期骨性融合率高,且能有效改善病人足踝功能,是治疗终末期踝关节炎的一种理想的手术方法。

Objective To evaluate the effect of arthroscopic anlcle arthrodesis using double-parallel headless compression screw for ankle arthritis. Methods The study included 16 patients who underwent arthroscopy with double parallel headless compression screws for ankle arthrodesis (the minimally invasive group) and 12 patients who underwent open ankle arthrodesis(the open group) from March 2016 to September 2017. The bony fusion rates 3 months and 1 year after surgery and the American orthopedic foot and ankle society(AOFAS) scores were evaluated and compared in the two groups. Results At 3 months postoperatively, the bony fusion rate was 93.8%(15/16) in the minimally invasive group and 66.7%(8/12) in the open group. The difference was statistically significant (χ 2=5.328, P = 0.013). All patients achieved bony fusion 1 year after operation. The AOFAS score of the minimally invasive group 3 months after operation was 65.3±2.7, which was significantly higher than that of the open group (53.8±2.1)( t = 1.839, P < 0.05). The AOFAS score of the minimally invasive group was 75.3±2.7 one year after operation, which was significantly higher than that of the open group (68.8±2.5)( t = 7.526, P < 0.01). Conclusions Arthroscopic application of double parallel headless compression screws for ankle arthritis has a high rate of early bony fusion and can effectively improve the ankle function of the patients. It is an ideal surgical method for the treatment of end-stage ankle arthritis.