新型微创接骨板治疗内翻型踝关节炎的早期疗效

Early effectiveness of a new minimally invasive plate in treatment of varus-type ankle arthritis

目的 探讨新型微创接骨板治疗内翻型踝关节炎的早期疗效。方法 回顾性分析2021年3月-10月符合选择标准的15例内翻型踝关节炎患者临床资料。患者均行内侧撑开踝上截骨术联合腓骨截骨,采用新型微创接骨板固定截骨。男7例,女8例;年龄16~71岁,平均49.8岁。踝关节炎病因:骨折后畸形愈合1例,扭伤8例,后天马蹄足1例,无明显诱因5例。病程1~12年,平均4.1年。比较手术前后Takakura分期、美国矫形足踝协会(AOFAS)踝-后足评分、足部功能指数(FFI)、疼痛视觉模拟评分(VAS)以及胫骨远端关节面正位角(tibial anterior surface angle,TAS)、距骨倾斜角(talar tilt,TT)、胫骨远端关节面侧位角(tibial lateral surface angle,TLS)。结果 术后切口均Ⅰ期愈合。患者均获随访,随访时间7~18个月,平均12.8个月。末次随访时,AOFAS踝-后足评分、FFI、VAS评分及Takakura分期均较术前改善(P<0.05)。X线片复查示术后3个月随访时截骨均愈合;末次随访时TAS较术前增大、TT减小,差异均有统计学意义(P<0.05),而TLS与术前比较差异无统计学意义(P>0.05)。并发症包括1例术中螺钉断裂,2例患足神经损伤。随访期间患者均未诉放置钢板处明显不适,无内固定物松动发生。患者自评满意度达非常满意11例,比较满意4例。结论 新型微创接骨板用于治疗内翻型踝关节炎具有良好早期疗效,可缓解踝关节疼痛,矫正畸形,改善下肢力线及踝关节功能,且术后切口并发症发生率较低。

Objective e To evaluate the early effectiveness of a new minimally invasive plate in the treatment of varus-type ankle arthritis.MethodsA clinical data of 15 patients with varus-type ankle arthritis who met the selection criteria between March 2021 and October 2021 were retrospectively analyzed.All the patients were treated with medial open-wedge supramalleolar osteotomy and fibular osteotomy.The osteotomies were fixed with the new minimally invasive plate.There were 7 males and 8 females with an average age of 49.8 years(range,16-71 years).The causes of ankle arthritis included post-fracture deformity in 1 case,sprain in 8 cases,and acquired clubfoot in 1 case;and 5 cases were without obvious factors.The disease duration ranged from 1 to 12 years,with an average of 4.1 years.Comparisons were made between pre-operation and the last follow-up in the Takakura staging,the American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,foot function index(FFI),visual analogue scale(VAS)score,tibial anterior surface angle(TAS),tibial lateral surface angle(TLS),and talar tilt(TT).Results All incisions healed by first intention.All patients were followed up 7-18 months(mean,12.8 months).At last follow-up,the AOFAS ankle-hindfoot score,FFI,VAS score,and Takakura staging significantly improved when compared with the preoperative ones(P<0.05).X-ray films showed that the osteotomy healed at 3 months after operation.At last follow-up,TAS significantly increased and TT decreased when compared with the preoperative ones(P<0.05),and the difference in TLS between pre-and postoperation was not significant(P>0.05).Complications included 1 case of intraoperative screw breakage and 2 cases of nerve injury of the affected foot.None of the patients complained of significant discomfort at the plate placement during follow-up,and no loosening of the internal fixator occurred.Eleven patients were very satisfied with the effeectiveness,while 4 were relatively satisfied.ConclusionThe new minimally invasive plate for the varus-type ankle arthritis has good early effectiveness in relieving ankle pain,correcting deformity,improving limb alignment and ankle function,and reducing the incidence of postoperative incisional complications.