踝上截骨与踝关节融合术治疗创伤性踝关节炎的临床疗效

Clinical effect of supramalleolar osteotomy and ankle joint fusion in the treatment of traumatic ankle arthritis

目的探讨踝上截骨术与踝关节融合术治疗创伤性踝关节炎的临床疗效。方法2017年1月~2019年3月新疆医科大学第六附属医院应用踝上截骨术治疗踝关节OA患者15例,踝关节融合术治疗踝关节OA患者10例,总共25例。23例获得完整随访。在23例患者中,选取随访时间达12个月以上的患者进行分析,即应用踝上截骨术的11例,应用踝关节融合术的7例。对这18例获得完整随访患者的术前、术后1个月及术后12个月时的X线片进行对比,应用美国足踝外科协会(AOFAS)踝关节功能评分系统对患者术前及术后12个月随访功能情况进行评估,同时比较术前及术后12个月随访时的VAS疼痛评分。结果18例患者获得平均16.8个月(13~26个月)随访。均达到骨性愈合,平均骨折以及踝关节融合愈合时间为7~8周。踝上截骨组AOFAS评分由术前平均(36.32±3.32)分提高到术后12个月时的平均(81.22±5.60)分,差异有统计学意义(t=-74.871,P=0.000);其中优2例,良8例,一般1例,优良率90.91%;VAS疼痛评分平均为(1.76±0.47)分,与术前比较差异有统计学意义(t=74.434,P=0.000)。踝关节融合组AOFAS评分由术前平均(22.85±6.50)分提高到术后12个月时的平均(81.35±4.58)分,差异有统计学意义(t=-44.056,P=0.000);其中优0例,良6例,一般1例,优良率85.7%;VAS疼痛评分平均为(2.70±0.63)分,较术前比较有统计学意义(t=35.928,P=0.000)。结论踝上截骨术与踝关节融合术在踝关节创伤性踝关节炎患者中均可达到满意效果。

Objective To investigate the clinical effect of supramalleolar osteotomy and ankle fusion in the treatment of traumatic arthritis of ankle.Methods From January 2017 to March 2019,15 patients with ankle OA were treated with supramalleolar osteotomy and 10 patients with ankle fusion,a total of 25 patients.23 cases were followed up completely.Among 23 patients,11 cases were treated with supramalleolar osteotomy and 7 cases were treated with ankle fusion.The X-ray films of 18 patients with complete follow-up were compared before operation,1 month after operation and 12 months after operation.The ankle function score system of American Association of Ankle Surgery(AOFAS)was used to evaluate the patients’follow-up function before operation and 12 months after operation,and the VAS pain score before operation and 12 months after operation was compared.Results Eighteen patients were followed up for an average of 16.8 months(13-26 months).The average healing time of fracture and ankle joint fusion was 7-8 weeks.AOFAS score in supramalleolar osteotomy group increased from preoperative average(36.32+3.32)to preoperative average(81.22+5.60)at 12 months postoperatively.There were significant differences compared with preoperative average(t=-74.871,P=0.000).Among them,2 cases were excellent,8 cases were good,1 case was normal,the excellent and good rate was 90.91%,and the VAS pain score was(1.76+0.47).There were significant differences compared with preoperative average(t=74.434,P=0.000).The AOFAS score in ankle fusion group increased from the preoperative average(22.85+6.50)to the 12-month average(81.35+4.58).There was statistical significance(t=-44.056,P=0.000)compared with the preoperative ones.There were 0 excellent cases,6 good cases and 1 general case.The excellent and good rate was 85.7%.The average VAS pain score was(2.70+0.63).There was statistical significance compared with the preoperative ones(t=35.928,P=0.000).Conclusion Supramalleolar osteotomy and ankle fusion can achieve satisfactory results in patients with traumatic ankle arthritis.