踝上弧形截骨联合软组织平衡手术治疗内翻型踝关节骨性关节炎疗效评估

Evaluation of curative effect of dome-shaped supramalleolar osteotomy combined with soft tissue balance for treatment of varus ankle osteoarthritis

目的 评估踝上弧形截骨联合软组织平衡手术治疗内翻型踝关节骨性关节炎的临床疗效。方法 回顾性分析自2018-07—2020-12采用踝上弧形截骨联合软组织平衡手术治疗的20例改良Takakura Ⅱ期内翻型踝关节骨性关节炎。经踝关节前外侧入路显露胫骨远端及腓骨远端,在胫骨关节面中心向上约3 cm处定为弧形截骨的顶点,用电刀在骨面上烫出预截骨的弧形线。比较术前与末次随访时疼痛VAS评分、踝与后足功能AOFAS评分、胫骨远端关节面角、距骨倾斜角、胫骨远端关节面侧位角。结果 20例均获得随访,随访时间平均21(9~36)个月。末次随访时改良Takakura分期:Ⅰ期12例,Ⅱ期8例。末次随访时踝与后足功能AOFAS评分为(89.60±4.80)分,较术前(72.70±2.61)分明显提高;末次随访时疼痛VAS评分为(1.20±0.75)分,较术前(5.90±0.83)分明显降低,差异有统计学意义(P<0.05)。末次随访时胫骨远端关节面角较术前增加,距骨倾斜角较术前减小,差异有统计学意义(P<0.05)。末次随访时胫骨远端关节面侧位角与术前比较差异无统计学意义(P>0.05)。结论 踝上弧形截骨联合软组织平衡手术治疗改良TakakuraⅡ期内翻型踝关节骨性关节炎的疗效满意,可获得良好的畸形矫正效果,获得满意的疼痛缓解及功能恢复。踝上弧形截骨术中无需植骨,便于力线调整,值得临床推广应用。

Objective To evaluate the clinical efficacy of dome-shaped supramalleolar osteotomy combined with soft tissue balance in the treatment of varus ankle osteoarthritis. Methods Twenty patients with modified Takakura stage Ⅱ varus ankle osteoarthritis treated by supramalleolar dome osteotomy combined with soft tissue balance from July 2018 to December 2020 were retrospectively analyzed. The anterolateral approach to the ankle joint was adopted to expose the distal ends of the tibia and the fibula. The vertex of dome osteotomy was defined at 3 cm above the center of the tibial articular surface, followed by a scalding pre-cut arc line on the bone surface with an electrotome. The VAS pain scores, AOFAS ankle-posterior foot scores, tibial anteroposterior surface angle, talar tilt angle, and tibial lateral surface angle were compared before surgery and at the last follow-up. Results All patients were followed up with a mean period of 21 (9-36) months. At the last follow-up, 12 patients were classified into modified Takakura stage Ⅰ and 8 patients stage Ⅱ;AOFAS ankle-posterior foot scores (89.60±4.80) were significantly improved compared with the results before surgery (72.70±2.61);VAS scores (1.20±0.75) were significantly reduced compared with those before surgery (5.90±0.83), suggesting statistically significant differences (P<0.05). Compared with the conditions before surgery, the tibial anteroposterior surface angle was increased and the talar tilt angle was decreased at the last follow-up, and the differences were statistically significant (P<0.05). However, the difference in tibial lateral surface angle was not statistically significant between the result at the last follow-up and that before surgery (P>0.05). Conclusion For patients with modified Takakura stage Ⅱ varus ankle osteoarthritis, supramalleolar dome osteotomy combined with soft tissue balance is associated with satisfactory efficacy, good deformity correction, pain relief and functional recovery. It requires no bone grafting and is very convenient for force line restoration, indicating its high value in clinical application.