经腓骨下段截骨联合空心螺钉行胫距关节融合术治疗重度踝关节骨关节炎的临床疗效

Clinical effect of distal fibula osteotomy combined with hollow screw tibia-talus arthrodesis in the treatment of severe ankle osteoarthritis

目的观察经腓骨下段截骨联合3枚全螺纹空心加压螺钉行胫距关节融合术治疗重度踝关节骨关节炎的临床疗效。方法回顾性分析2018年9月至2021年10月采用经踝关节外侧入路腓骨下段截骨联合3枚全螺纹空心加压螺钉固定治疗的12例重度踝关节骨关节炎患者资料。其中,男8例,女4例,平均年龄57.8岁,身体质量指数(BMI)平均为25.67 kg/m^(2),根据Takakura分级均属于Ⅲb-Ⅳ级。采用疼痛视觉模拟评分(VAS)、KarlssonPeterson踝关节功能评分(Karlsson)术前、术后对比,评估术后踝关节功能及疼痛改善情况。结果12例患者随访12~18个月,平均15个月。VAS评分术前5~8分,与末次随访1~3分比较,差异有统计学意义(P<0.05);Karlsson术前评分45~55分,与术后末次随访评分70~86分比较,差异有统计学意义(P<0.05)。所有患者胫距关节均骨性融合,无切口感染、内固定断裂等并发症。结论重度踝关节骨关节炎经腓骨下段截骨联合空心螺钉行胫距关节融合术治疗,术后踝关节疼痛缓解明显,患者术后满意度较高。

Objective To observe the clinical effect of tibia-talus arthrodesis via distal fibula osteotomy combined with three full thread hollow compression screws in the treatment of severe ankle osteoarthritis.Methods The data of 12 patients with severe ankle osteoarthritis who underwent distal fibula osteotomy combined with hollow screw tibia-talus arthrodesis from September 2018 to October 2021 were retrospectively analyzed.There were 8 males and 4 females,with a mean age of 57.8 years,and the mean body mass index(BMI)was 25.67 kg/m^(2),which belonged to classⅢb-Ⅳaccording to Takakura classification.The visual analogue scale(VAS)and Karlsson-Peterson ankle function score(Karlsson)were compared before and after surgery.The Wilcoxon signed-rank sum test of paired samples was used to evaluate the improvement of postoperative ankle function and pain.Results Twelve patients were followed up for 12-18 months(mean 15 months).The VAS score was 5-8 points before operation and 1-3 points at the last follow-up(P<0.05),and the Karlsson score was 45-55 points before operation and 70-86 points at the last follow-up(P<0.05).All patients had bone fusion of the tibial talar joint,and there were no adverse complications such as incision infection and fracture of internal fixation.Conclusion The treatment of severe ankle osteoarthritis by tibial-talus arthrodesis via distal fibula osteotomy combined with three full thread hollow compression screws has obvious relief of postoperative ankle pain and higher postoperative satisfaction.