外踝截骨与关节镜下踝关节融合的疗效观察

Comparison of open lateral arthrodesis versus arthroscopic ankle arthrodesis

[目的]比较开放外侧踝关节融合与关节镜踝关节融合的临床疗效。[方法]回顾性分析2015年1月~2018年12月本科行踝关节融合治疗的终末期踝关节病患者47例,依据手术方式,27患者采用开放外侧踝关节融合术,20例采用关节镜下融合术,比较两组患者围手术期、随访与影像资料。[结果]两组患者均顺利完成手术,开放外侧融合组手术时间显著短于关节镜融合组(P<0.05),但开放外侧融合组术后引流量和平均住院时间显著大于关节镜融合组(P<0.05)。两组患者均随访12个月以上,随时间推移,两组患者VAS评分显著减少,而AOFAS评分显著增加(P<0.05)。术前和术后12个月时,两组间VAS和AOFAS评分间差异无统计意义(P>0.05),但术后6个月,关节镜融合组的VAS和AOFAS评分显著优于开放外侧融合组(P<0.05)。影像方面,术后3个月时两组患者踝关节融合率差异无统计学意义(P>0.05),术后6个月时,所有患者均获骨性融合。术后复查开放外侧融合组胫距角外翻角显著大于关节镜融合组(P<0.05)。[结论]开放外侧踝关节融合与关节镜踝关节融合均能有效纠正畸形、改善踝关节功能,相比之下,关节镜融合术医源性损伤小,近期临床效果更好。

[Objective]To compare the clinical outcomes of open lateral ankle arthrodesis versus arthroscopic ankle arthrodesis.[Methods]A retrospective study was conducted on 47 patients who received ankle arthrodesis for end-stage ankle arthrosis from January 2015 to December 2018 in our department.In term of surgical procedure performed,27 patients received open lateral ankle arthrodesis,while the remaining 20 patients underwent arthroscopic ankle arthrodesis.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]All patients in both groups received successful operation.The open group consumed significantly shorter operation than the arthroscopic group(P<0.001),whereas the former had significantly greater postoperative drainage and hospital stay than the latter(P<0.001).As time went during followup period more than 12 months,the VAS score significantly decreased,whereas the AOFAS score significantly increased in both group(P<0.001).Regardless no statistical significances before operation and at 12 months after operation(P>0.05),the arthroscopic group proved superior to the open group at 6 months in VAS and AOFAS scores(P<0.001).Regarding to imaging assessment,all the patients got bony fusion at 6 months after operation,without a statistically significant difference in fusion rate at 3 months between the two group(P>0.05).The open group had significantly greater postoperative tibiotalar valgus angle than the arthroscopic group(P<0.05).[Conclusion]Both open lateral ankle arthrodesis and arthroscopic ankle arthrodesis is effective procedure to correct deformity and improve function for end-stage ankle arthrosis,by contrast,the arthroscopic arthrodesis is superior to the conventional open one with benefits of minimizing iatrogenic trauma and improving outcomes.