逆行髓内钉与加压空心螺钉在胫距跟关节融合术治疗后足畸形中的疗效比较

Comparison of retrograde intramedullary nail and cannulated compression screw in tibiotalocalcaneal arthrodesis in the treatment of hindfoot deformity

目的比较逆行髓内钉与加压空心螺钉在胫距跟关节融合术治疗后足畸形中的临床疗效。方法回顾性分析2017年8月至2020年7月在西安交通大学附属红会医院行胫距跟关节融合术治疗后足畸形的58例患者的临床资料,其中28例采用逆行髓内钉固定(髓内钉组),30例采用加压空心螺钉固定(螺钉组)。术前及末次随访时,采用美国足踝外科协会(American Orthopaedic Foot And Ankle Society,AOFAS)踝-后足功能评分、视觉模拟评分法(visual analogue scale,VAS)评分评估疗效,并记录随访期间关节融合时间及并发症发生情况。结果所有患者均获随访,随访时间12~46(27.4±8.7)个月。髓内钉组1例、螺钉组2例患者术后出现浅表伤口感染,经口服抗生素及换药对症治疗3周后治愈。56例获得一期融合,总体融合率为96.55%,螺钉组2例患者出现骨延迟愈合;髓内钉组平均融合时间为(3.6±0.5)个月,螺钉组平均融合时间为(3.7±1.2)个月。髓内钉组、螺钉组VAS评分分别由术前(7.3±2.3)分、(7.2±2.5)分改善至末次随访时的(1.6±0.5)分、(1.7±0.8)分,AOFAS评分由术前(30.1±14.8)分、(32.7±15.3)分改善至末次随访时的(70.6±23.5)分、(69.2±22.5)分,组内术前与随访时分别比较差异有统计学意义(P<0.05),但组间术前、术后比较差异无统计学意义(P>0.05)。结论逆行髓内钉与加压空心螺钉在胫距跟关节融合术治疗后足畸形中均获得了较高的融合率,两种方式末次随访时的临床疗效相似,但螺钉组易于操作学习、创伤较小。

Objective To compare the clinical efficacy of retrograde intramedullary nail and cannulated compression screw in the treatment of hindfoot deformity with tibial talocalcaneal arthrodesis.Methods The clinical data of 58 patients with hindfoot deformity who underwent tibial talocalcaneal arthrodesis in Red Cross Society Hospital Affiliated to Xi’an Jiaotong University from August 2017 to July 2020 were retrospectively analyzed.Among them,28 cases were fixed with retrograde intramedullary nail(intramedullary nail group)and 30 cases were fixed with cannulated compression screw(screw group).The American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot function score and visual analogue scale(VAS)score were used to evaluate the efficacy preoperatively and last follow-up.Fusion time and complications during follow-up were recorded.Results All patients were followed up 12~46(27.4±8.7)months.Superficial wound infection occurred in 1 patient in the intramedullary nail group and 2 patients in the screw group,which were cured with oral antibiotics and dressing change after 3 weeks.56 patients achieved primary fusion,and the overall fusion rate was 96.55%.2patients in the screw group had delayed bone union.The mean fusion time was(3.6±0.5)months in the intramedullary nail group and(3.7±1.2)months in the screw group.The VAS score of intramedullary nail group and screw group were improved from preoperatively(7.3±2.3)points and(7.2±2.5)points to last follow-up(1.6±0.5)points and(1.7±0.8)points respectively,AOFAS score improved from(30.1±14.8)points and(32.7±15.3)points preoperatively to(70.6±23.5)points and(69.2±22.5)points at last follow-up,there was statistically significant difference between preoperative and follow-up in the group(P<0.05),but there was no statistically significant difference between the groups(P>0.05).Conclusion Both the retrograde intramedullary nail and cannulated compression screw can achieve high fusion rate in the treatment of hindfoot deformity.The clinical efficacy of the two methods is similar at the last follow-up,but the screw group is easy to learn and has less traumatic.