关节镜下踝关节融合术与人工全踝关节置换术治疗创伤性踝关节炎的临床效果比较

Comparison of clinical effect of arthroscopic ankle arthrodesis and total ankle arthroplasty in the treatment of traumatic ankle arthritis

目的 比较关节镜下踝关节融合术与人工全踝关节置换术治疗创伤性踝关节炎的临床效果.方法 回顾性分析2012年1月至2015年12月于我院经保守治疗无效的56例(56踝)创伤性踝关节炎患者的临床资料,根据不同术式将患者分为对照组(26例,26踝)与观察组(30例,30踝).对照组行人工全踝关节置换术,观察组行关节镜下踝关节融合术.比较两组患者的疗效.结果 观察组患者的手术时间长于对照组,术中出血量少于对照组,手术费用低于对照组,术后住院时间短于对照组(P<0.05).术后6个月、1年,两组患者的Kofoed、AOFAS评分均升高,且对照组均高于观察组(P<0.05).术后6个月、1年,两组患者的VAS评分均降低(P<0.05).观察组术后并发症总发生率低于对照组(P<0.05).观察组患者的翻修率低于对照组,轻度跛行率高于对照组(P<0.05).结论 关节镜下踝关节融合术及人工全踝关节置换术治疗创伤性踝关节炎各有优势,临床应根据患者实际情况选择合适的手术方式,旨在降低患者并发症发生率,提升其生存质量.

Objective To compare the clinical effects of arthroscopic ankle arthrodesis and total ankle arthroplasty in the treatment of traumatic ankle arthritis. Methods The clinical data of 56 patients(56 ankles) with traumatic ankle arthritis who had no effect after conservative treatment in our hospital from January 2012 to December 2015 were retrospectively analyzed. According to different operation methods, the patients were divided into control group(26 cases, 26 ankles) and observation group(30 cases, 30 ankles). The control group was given with total ankle arthroplasty, and the observation group was given arthroscopic ankle arthrodesis. The treatment effects of the two groups were compared. Results The operation time in the observation group was longer than that in the control group, the amount of intraoperative bleeding was less than that in the control group, the operation cost was lower than that in the control group, and the postoperative hospital stay was shorter than that in the control group(P <0.05). At 6 months and 1 year after operation, the scores of Kofoed and AOFAS in the two groups increased, and those in the control group were higher than the observation group( P<0.05). At 6 months and 1 year after operation, the VAS scores of the two groups decreased(P<0.05). The total incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05). The revision rate in the observation group was lower than that in the control group, and the mild claudication rate was higher than that in the control group(P<0.05). Conclusion Arthroscopic ankle arthrodesis and total ankle arthroplasty have their own advantages in the treatment of traumatic ankle arthritis. In clinical practice, the appropriate operation method should be chosen according to the actual situation of patients, so as to reduce the incidence of complications and improve the quality of life of patients.