经外侧入路带血供的1/2腓骨瓣用于踝关节融合的临床研究

Clinical research of ankle fusion with vascularised semi-split fibular flap via lateral approach

目的探讨经外侧入路带血供的1/2腓骨瓣用于踝关节融合的临床疗效。方法回顾性分析2015年6月至2020年12月武汉大学中南医院创伤与显微骨科收治的经外侧入路行踝关节融合的患者54例,其中,应用带血供的1/2腓骨瓣踝关节融合术27例(腓骨瓣组),应用外侧钢板的踝关节融合术27例(钢板组)。两组患者均由同一组医师完成手术,通过融合成功率、美国足踝外科协会(AOFAS)踝-后足评分系统、视觉模拟评分(VAS)对两组临床疗效进行评估。术后患者通过门诊复查随访。结果两组患者随访12~24个月,平均15个月。术后6个月时腓骨瓣组有24例达到骨性愈合,融合成功率为88.9%,钢板组有17例达到骨性愈合,融合成功率为63.0%,差异有统计学意义(P<0.05)。术后1年时腓骨瓣组27例全部达到骨性愈合,融合成功率为100.0%,钢板组有23例达到骨性愈合,有4例患者未愈合,融合成功率为85.2%,差异有统计学意义(P<0.05)。腓骨瓣组术前、术后6个月和术后1年的AOFAS评分分别为(41.3±12.0)分、(65.6±5.6)分、(79.1±7.0)分,钢板组相同时间点的评分分别为(40.8±11.3)分、(64.5±4.1)分、(69.3±7.2)分,两组术前、术后6个月的得分差异无统计学意义(P>0.05)。两组术后1年的得分差异,腓骨瓣组明显高于钢板组患者,差异有统计学意义(P<0.05)。腓骨瓣组术前VAS评分为(7.6±1.3)分,钢板组术前VAS评分为(7.5±1.1)分,差异无统计学意义(P>0.05);钢板组术后1年VAS评分为(1.8±0.9)分,腓骨瓣组术后1年VAS评分为(1.9±0.8)分,差异有统计学意义(P<0.05)。结论经外侧入路带血供的1/2腓骨瓣踝关节融合术的并发症少,且融合成功率高于经外侧入路钢板固定的踝关节融合术,值得临床推广应用。

Objective To investigate the clinical efficacy of the vascularised semi-split fibular flap with lateral approach in ankle fusion.Methods A total of 54 patients who underwent ankle fusion through the lateral menstrual approach by the Department of Trauma and Micro Orthopaedics,Zhongnan Hospital of Wuhan University from June 2015 to December 2020 was retrospectively analysed.Of the 54 patients,27 patients who underwent ankle fusion with a semi-split fibular flap carrying blood supply were assigned to the fibular flap group,while other 27 patients who had ankle fusion with lateral plate were assigned to the plate group.The ankle fusions for both groups were performed by the same surgical team.The clinical efficacy of the 2 groups was evaluated by the success rate of bone fusion,the American Orthopedic Foot and Ankle Surgery(AOFAS)Ankle-Hindfoot Score System,and the Visual analog score(VAS).All the patients entered the postoperative follow-up at outpatient clinic.Results The follow-up lasted for 12-24 months,with an average of 15 months.At 6 months after surgery,24 patients in the fibular flap group achieved osseous union with 88.9%in the success rate of bone fusion.While 17 patients in the plate group achieved osseous union,with the success rate of bone fusion at 63.0%.There was a statistically significant difference between the groups(P<0.05).At 1 year after surgery,all 27 patients in the fibular flap group achieved bony union,with a 100%of the success rate of bone fusion,while 23 patients in the plate group achieved bony union at a 85.2%success rate of bone fusion,with 4 patients failed to heal.The difference was statistically significant(P<0.05).The AOFAS scores of the fibular flap group were 41.3±12.0,65.6±5.6,and 79.1±7.0 before operation,at 6 months after operation and 1 year after operation,respectively,while the scores for the plate group at the same time were 40.8±11.3,64.5±4.1 and 69.3±7.2.There was no significant difference in the scores between the groups before surgery and at 6 months after the operation(P>0.05).The scores at 1 year after surgery in the fibular flap group was significantly higher than the plate group,and there was a statistically significant difference(P<0.05).The preoperative VAS score in the fibular flap group was 7.6±1.3,while it was 7.5±1.1 in the plate group.There was no significant difference between the groups in VAS score(P>0.05).However,the VAS score at 1 year after surgery was found at 1.8±0.9 in the plate group,and 1.9±0.8 in the fibular flap group and the difference between groups was statistically significant(P<0.05).Conclusion The surgical procedure of semi-split fibular flap through the lateral approach has lower complications and higher success rate in ankle fusion in comparison with those of the fusion with lateral plate.Thus,further clinical investigations can be considered.