斜形踝上截骨治疗内翻性踝关节炎的初期疗效研究

Preliminary radiological result and clinical effect of oblique supramalleolar tibial osteotomy(SMO)in treatment of varus ankle osteoarthritis

目的探讨斜形踝上截骨术治疗内翻性踝关节炎的初期临床效果。方法于2013年1月—2019年12月回顾性研究了佛山市中医院52例采用踝上截骨治疗的内翻性踝关节炎患者。根据Takakura踝关节炎的分级,其中Ⅰ级0例、Ⅱ级16例、ⅢA级22例、ⅢB级14例、Ⅳ级0例。采用Woo-Chun Lee的斜形截骨方法,并根据需要联合腓骨截骨和外侧副韧带重建术治疗,术后拍片测量胫骨关节面角(tibial articular surface angle,TAS角)、胫骨侧面角(tibial lateral surface angle,TLS角)、距骨倾斜角(talar tilit angle,TT角)情况,使用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝-后足评分和视觉模拟评分法(visual analogue scale,VAS)评估踝关节的功能和疼痛情况,并观察患者早期和晚期的并发症发生情况。结果50例(50/52)患者随访时间为24~63个月,平均为(46.2±12.6)个月,早期术口并发症:皮肤边缘浅表坏死4例,浅表感染2例,经换药后术口愈合,无深部感染病例。所有患者愈合时间为(10.9±0.9)周,无延迟愈合和不愈合患者。TAS角由术前(85.3°±1.8°)至术后(93.4°±2.2°),前后差异有统计学意义(P<0.05);TLS角由术前(79.8°±1.1°)至术后(80.1°±1.1°),前后差异有统计学意义(P>0.05);TT角由术前(5.3°±3.7°)降低至术后(2.1°±1.6°),前后差异有统计学意义(P<0.05)。AOFAS评分由术前(50.0±7.5)分提高至术后(78.0±8.0)分,前后差异有统计学意义(P<0.05);VAS评分由术前(7.4±1.2)分降低至术后(3.3±0.8)分,前后差异有统计学意义(P<0.05)。其中4例患者症状无显著改善,2例患者拒绝一进步手术治疗,2例患者行踝关节融合术后症状得到缓解。结论斜形踝上截骨能显著改善轻中度内翻性踝关节炎患者的影像学指标,具有良好的临床疗效。

Objective To discuss the preliminary clinical effect of oblique supramalleolar tibial osteotomy(SMO)in treatment of varus ankle osteoarthritis.Methods From January 2013 to December 2019,52 patients with symptomatic varus ankle arthritis treated with supramalleolar osteotomy were retrospectively studied.According to Takakura’s classification of ankle arthritis,there were 0 cases of gradeⅠ,16 cases of gradeⅡ,22 cases of gradeⅢA,14 cases of gradeⅢB and 0 case of gradeⅣ.The oblique osteotomy method of Woo-Chun Lee was used,and fibular osteotomy and lateral collateral ligament reconstruction were combined according to the need.The TAS,TLS and TT angles were measured after operation.The ankle function and pain were evaluated by AOFAS and VAS scores,and the early and late complications were observed.Results Fifty patients(50/52)were followed up for(46.2±12.6)(24~63)months.Early postoperative complications included superficial necrosis of skin margin in 4 cases and superficial infection in 2 cases.The wound healed after dressing change without deep infection.All patients reached union at(10.9±0.9)(10~12)weeks,and there was no delayed union or nonunion.TAS angle was(85.3°±1.8°)preoperatively and(93.4°±2.2°)postoperatively,P<0.05.TLS angle was(79.8°±1.1°)preoperatively and(80.1°±1.1°)postoperatively,P>0.05.TT angle was(5.3°±3.7°)before surgery and(2.1°±1.6°)after surgery,P<0.05.AOFAS score improved from(50.0±7.5)points preoperatively to(78.0±8.0)points postoperatively,P<0.05;VAS score decreased from(7.4±1.2)points preoperatively to(3.3±0.8)points postoperatively,P<0.05.4 patients had no obvious improvement in symptoms,but 2 patients refused further operation,and 2 patients were relieved after ankle arthrodesis.Conclusion Oblique supramalleolar osteotomy can significantly improve the imaging indexes of patients with mild to moderate varus ankle arthritis,and has good clinical effect.