锁定型后足融合髓内钉胫距跟融合术治疗距骨周围病变的疗效分析

Tibiotalar calcaneus fusion with locking posterior foot fusion intramedullary nail in the treatment of peri-talus lesions

目的探讨锁定型后足融合髓内钉行胫距跟关节融合术(tibiotalocalcaneal arthrodesis,TTCA)临床疗效。方法2013年1月至2020年1月,应用锁定型后足融合髓内钉行TTCA治疗17例距骨周围病变患者。男5例,女12例。年龄27~65岁,平均43.5岁。踝关节骨性关节炎7例,距骨缺血坏死5例,马蹄内翻足4例,其它固定方式踝关节融合失败1例。通过体格检查、踝关节负重正侧位X线片及美国足踝协会(American orthopedic foot and ankle society,AOFAS)踝与后足功能评分进行评估。结果随访36~63个月,平均43.1个月。1例出现伤口周围皮下血肿,1例出现远端锁钉局部刺激症状,1例出现髓内钉应力骨折,所有患者均骨性融合。AOFAS踝与后足功能评分,术前(44.65±13.37)分,术后1年(68.35±4.02)分,术后2年(80.35±5.37)分,术后3年(80.53±6.25)分。术前、术后1年、术后1~2年AOFAS后足评分差异有统计学意义。术后2~3年AOFAS后足评分差异无统计学意义。结论锁定型后足融合髓内钉是行TTCA的一种安全、有效的内固定方法。

Objective To investigate clinical effects of tibiotalar calcaneus fusion with locking posterior foot fusion intramedullary nail in the treatment of peri-talus lesions.Methods Seventeen patients with peri-talus lesions were treated with tibiotalar calcaneus fusion with locking posterior foot fusion intramedullary nail from January 2013 to January 2020.There were 5 males and 12 females with an average age of 43.5 years (range:27-65 years).There were 7 cases of ankle osteoarthritis,5 cases of talus ischemic necrosis,4 cases of equinovarus and 1 case of ankle fusion failure.Physical examination,weight bearing AP and lateral X-ray films of the ankle,AOFAS ankle and hindfoot function scores were assessed.Results The average follow-up was 43.1 months (range:36-63 months).Subcutaneous hematoma around the wound was observed in 1 patient,local stimulation symptoms of distal locking nail in 1 patient,and intramedullary nail stress fracture in 1 patient.Bone union was achieved in all patients.AOFAS results:(44.65±13.37) before operation;(68.35±4.02) 1 year after operation;(80.35±5.37)2 years after operation;(80.53±6.25) 3 years after operation.Significant differences were seen preoperatively and 1 year postoperatively,1 year postoperatively and 2 years postoperatively,but not 2 years postoperatively and 3 years postoperatively.Conclusions Tibiotalar calcaneus fusion with locking posterior foot fusion intramedullary nail is safe and effective in the treatment of peri-talus lesions.