两种固定方法在胫距跟关节融合术中的应用

Application of two kinds of fixation methods on tibiotalocalcaneal arthrodesis

目的探讨逆行髓内钉和双锁定钢板固定在胫距跟关节融合术中的应用效果。方法行胫距跟关节融合治疗63例患者,其中25例采用双锁定钢板固定(观察组),38例采用逆行髓内钉固定(对照组)。术后比较两组融合效果、AOFAS评分、SF-36评分及并发症发生率。结果患者均获得随访,对照组随访时间13~18(16.39±2.82)个月;观察组随访时间13~21(16.05±2.73)个月。观察组一期骨融合率和翻修率均显著优于对照组(P<0.05)。两组一期骨性融合时间比较差异均无统计学意义(P>0.05)。术后12个月AOFAS评分和SF-36评分两组比较差异均无统计学意义(P>0.05)。术后并发症发生率观察组显著高于对照组(P<0.05)。结论胫距跟关节融合术中双锁定钢板固定可有效提高骨性融合效果,但逆行髓内钉固定有助于降低术后并发症发生率。

Objective To investigate the effects of retrograde intramedullary nail and double locking plates fixation for tibiotalocalcaneal arthrodesis(TTCA).Methods The 63 patients undergoing TTCA were divided into two groups,including control group(38 patients were treated with retrograde intramedullary nail)and observation group(25 patients were treated with double locking plates fixation).And the fusion effect,AOFAS score,SF-36 score and complications incidence rate of two groups were compared.Results The follow-up time of the control group and the observation group was 13~18(16.39±2.82)months and 13~21(16.05±2.73)months,respectively.The bone fusion rate in one-stage and revision rate of observation group were significantly better than control group(P<0.05).There was no significant difference in the bone fusion time between two groups(P>0.05).There were no significant differences in the AOFAS score and SF-36 score at 12 months after operation between two groups(P>0.05).The complications incidence rate of observation group was significantly higher than that of control group(P<0.05).Conclusions Double locking plates in the treatment of patients undergoing TTCA can efficiently improve bone fusion effects,but retrograde intramedullary nail application is helpful to reduce the postoperative complications risk.