内翻型踝关节炎踝上截骨联合内侧牵开与否比较

Supramalleolar osteotomy with or without medial retraction arthroplasty for varus ankle osteoarthritis accompanied with talar tilt

[目的]比较踝上截骨(supramalleolar osteotomy,SO)联合或不联合内侧关节牵开(medial distraction arthroplasty,MDA)治疗伴有距骨倾斜(talar tilt,TT)的内翻型踝关节骨性关节炎的临床效果。[方法]回顾性分析手术治疗内翻型踝关节骨性关节炎患者34例,其中,单纯行SO术16例,SO联合MDA术18例。比较两组围手术期、随访与影像学资料。[结果]两组患者均顺利手术,术中无血管、神经损伤等严重并发症。两组患者随访时间平均(41.82±16.29)个月。随访过程中,SO组3例患者行翻修踝关节融合术;而SO-MDA组无需行关节融合术者。与术前相比较,末次随访时,两组患者的AOFAS评分显著增加(P<0.05),而AOS疼痛评分和AOS功能评分均显著下降(P<0.05)。末次随访时,SO-MDA组AOFAS评分、AOS疼痛评分和AOS功能评分均优于SO组,但两组间差异无统计学意义(P>0.05)。影像学方面,与术前相比,末次随访时两组Takakura分期均有显著改善(P<0.05),TAS、TC显著增加(P<0.05),而TT、TMM和HFA显著减少(P<0.05)。末次随访时,SO-MDA组的Takakura分期和TT的改善优于SO组。[结论]踝上截骨术联合内侧牵开术,可以更好的治疗伴有TT角增大的内翻型踝关节骨性关节炎。

[Objective]To compare clinical outcomes of supramalleolar osteotomy(SO)with or without medial distraction arthroplasty(MDA)for varus ankles osteoarthritis accompanied with talar tilt(TT).[Methods]A retrospective analysis was performed on 34 patients who underwent surgical treatment for varus ankle osteoarthritis.Among them,16 patients underwent SO alone,while the remaining 18 patients underwent SO combined with MDA.The documents regarding to perioperative period,follow-up and radiographs were compared between the two groups.[Results]All the patients in both groups were successfully operated without serious complications,such as vascular and nerve damage,and were followed up for(41.82±16.29)months.During the follow-up,the SO group had 3 patients received revision ankle fusion,whereas the SO-MDA group had nobody required revision ankle fusion.Compared with those preoperatively,the AOFAS score increased significantly(P<0.05),while the AOS pain score and AOS functional score decreased significantly in both groups at the latest follow-up(P<0.05).The SO-MDA group was superior to the SO group in terms of AOFAS score,AOS pain score,AOS function score at the latest follow-up,although there was no significant difference(P>0.05).Regarding radiographic assessment,the Takakura’s staging significantly improved(P<0.05),TAS and TC were significantly increased(P<0.05),while TT,TMM and HFA significantly reduced at the latest follow up in both groups compared with those preoperatively(P<0.05).At the latest follow-up,the SO-MDA group proved superior to the SO group in terms of the improvement of Takakura staging and TT.[Conclusion]The supramalleolar osteotomy combined with medial distraction arthroplasty does treat varus ankle osteoarthritis accompanied by increased TT angle more effectively.