经外踝截骨联合空心钉和肱骨近端锁定钢板倒置固定行胫距跟融合术的疗效观察

Clinical outcome of tibiotalocalcaneal fusion using cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach

目的:探讨经外踝截骨联合空心钉和肱骨近端锁定钢板倒置固定在胫距跟关节融合的临床疗效。方法:自2015年6月至2018年12月,采用经外踝截骨联合空心钉和肱骨近端锁定钢板倒置固定行胫距跟融合术患者15例,其中男10例,女5例;年龄45~72(58.9±6.1)岁;病程2~35(11.9±7.9)年。术前诊断创伤性关节炎8例,Charcot关节炎2例,Charcot-Marie-Tooth(CMT)2例,踝关节结核1例,距骨坏死1例,色素沉着绒毛结节性滑膜炎1例。8例合并单纯内翻畸形,4例合并单纯外翻畸形,2例合并马蹄内翻畸形,1例合并马蹄畸形,2例合并中前足内收内旋。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分及疼痛视觉模拟评分(visual analogue scale,VAS)进行临床疗效评价。结果:14例患者获得随访,时间10~25(16.6±4.3)个月,1例失访,切口均Ⅰ期愈合,融合时间术后15~24(16.8±2.4)周。1例合并糖尿病患者骨融合延迟,通过Ⅰ期再植骨注入富血小板血浆(platelet-rich plasma,PRP)后融合。AOFAS评分由术前(38.7±3.3)分提高至术后(84.5±2.6)分,VAS评分由术前(7.5±1.6)分降至术后(1.9±0.3)分,差异有统计学意义(P<0.05)。结论:采用经外踝截骨空心螺钉联合肱骨近端锁定钢板倒置固定行胫距跟关节融合术手术操作简便,融合率高,且对伴有后足畸形的患者尤其适用。

Objective:To evaluate the clinical outcome of tibiotalocalcaneal fusion using cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach.Methods:From June 2015 to December 2018,15 patients underwent a tibiotalocalcaneal fusion operation using cannulated screw and inverted proximal humerus locking plate through a transfibular approach.There were 10 males and 5 females with the age ranging from 45 to 72(58.9±6.1)years,and the course of disease ranged from 2 to 35(11.9±7.9)years.Preoperative diagnosis included 8 cases of post-traumatic arthritis,2 cases of Charcot arthritis,2 cases of Charcot-Marie-Tooth(CMT),1 case of ankle tuberculosis,1 case of talar necrosis,and 1 case of pigmented villonnodular synovitis.Among them,8 patients were combined with simple varus deformity,4 patients with simple valgus deformity,2 patients with equinovarus deformity,1 patient with equinovarus deformity,2 patients with adduction and internal rotation of middle and forefoot.American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot score and the visual analogue scale(VAS)score were used to evaluate the clinical outcome at the last follow-up.Results:One lost follow-up and remaining fourteen patients were followed up.The follow-up time ranged from 10 to 25(16.6±4.3)months.All the 15 patients had primary healing.Fusion time ranged from 15 to 24(16.8±2.4)weeks after operation.One patient with diabetes experienced delayed union and was successfully treated with secondary bone grafting combined with Platelet-Rich Plasma(PRP)injection.The AOFAS score increased from 38.7±3.3 to 84.5±2.6(P<0.05),and the VAS score decreased from 7.5±1.6 to 1.9±0.3(P<0.05).Conclusion:Tibiotalocalcaneal fusion used cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach has the advantages of relatively simple technique,high fusion rate,especially for patients with posterior foot deformity,which has satisfactory short-term effects.