微创双切口踝关节融合的手术技术与疗效分析

Minimally invasive double incision technique for ankle arthrodesis and effect analysis

目的介绍踝关节前侧微创双切口行关节融合术的手术技术,并评估其临床疗效。方法回顾性分析2016年12月至2018年12月西安交通大学附属红会医院足踝外科收治的终末期踝关节炎患者23例(23足),其中男9例,女14例;年龄37~68岁,平均(53.4±8.5)岁;左侧10例,右侧13例;根据Kellgren-Lawrence分期,Ⅲ期4例,Ⅳ期19例。所有患者均采用微创双切口行关节融合术治疗,通过对比术前与末次随访的美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足评分、视觉疼痛量表(visual analog scale,VAS)评分进行临床疗效评估。结果本组23例患者的随访时间28~55个月,平均(44.75±9.42)个月。术后所有患者均获得骨性愈合,未出现严重的手术相关并发症。AOFAS评分、VAS评分较术前均有显著改善(P<0.001)。结论针对无明显内外翻畸形及骨缺损的踝关节炎患者,踝关节融合可获得满意的临床疗效,微创双切口技术创伤小、并发症少,中短期随访疗效肯定。

Objective The purpose of this study was to introduce the surgical technique and evaluate the clinical outcomes of arthrodesis with minimally invasiveincision in the ankle joint.Methods From December 2016 to December 2018,23 patients(23 feet)with end-stage ankle arthritis treated in foot and ankle surgery department of Honghui Hospital of Xi'an Jiaotong University were retrospectively analyzed,including 9 males and 14 females;the age was 37~68(53.4±8.5)years;10 cases on the left side and 13 cases on the right side;according to Kellgren-Lawrence classfication,4 cases in stageⅢand 19 cases in stageⅣ.All patients were treated with minimally incision arthrodesis.The clinical efficacy was evaluated by comparing the American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot score and visual analog scale(VAS)score before surgery and at the last follow-up.Results All 23 patients were followed up for 28~55(44.75±9.42)months.All patients achieved bone union after surgery,and no serious surgical complications occurred.AOFAS score and VAS score were significantly improved compared with those before operation(P<0.001).Conclusion For the ankle joint without obvious deformity of varus or valgus or bone defect,satisfactory clinical effect can be obtained by using ankle joint fusion.The minimally double incision technique has less trauma and fewer complications,and the short and mediumterm follow-up effect is positive.