踝上弧形截骨联合关节牵伸治疗内翻型踝关节炎

Supramalleolar Domeshaped Osteotomy Combined with Ilizarov Distraction Arthroplasty in the Treatment of Varus Ankle Osteoarthritis

目的评估踝上弧形截骨联合关节牵伸治疗内翻型踝关节炎的临床效果。方法回顾性分析2009年12月至2021年4月北京市垂杨柳医院骨二科治疗的8例内翻型踝关节炎病人的临床资料,男5例,女3例,年龄为(35.2±9.1)岁(27~45岁)。其中有踝部骨折史者5例,骨骺损伤后遗踝内翻畸形3例。应用踝上胫腓骨弧形截骨矫正踝内翻后安装Ilizarov踝关节牵伸器,术后行踝关节牵伸,维持关节间隙至5~8 mm行走3个月以上。根据病人手术前后胫骨远端关节面角(tibial articular surface angle,TAS)及美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分评估临床治疗效果。结果8例病人随访时间为(31.5±17.9)个月(12~72个月),外固定佩戴时间为(29.4±5.1)周(20~32周)。拆除外固定时截骨处均达到临床骨愈合标准,末次随访时AOFAS评分为(82.0±7.7)分(76~90分),TAS角度为91.1°±2.4°(89.6°~95.0°),与术前比较[(47.6±3.7)分(41~65分),82.9°±4.7°(72°~87°)],差异有统计学意义(P<0.05)。8例术后均出现局部针道感染,5例给予局部酒精敷料缠绕包扎,3例拔出感染固定针后感染控制。2例固定针折断,去除外固定装置时给予拔除,无其他严重并发症。结论踝上弧形截骨术联合踝关节牵伸成形治疗内翻型踝关节炎,矫正踝内翻效果满意,避免植骨内固定,截骨愈合良好。结合Ilizarov外固定牵伸,允许术后全负重行走锻炼,显著改善病人足踝功能,值得临床推广应用。

Objective To evaluate the clinical effect of supramalleolar domeshaped osteotomy combined with Ilizarov joint distraction in the treatment of varus ankle osteoarthritis.Methods A retrospective analysis was performed on 8 cases of varus ankle arthritis treated by Beijing Chuiyangliu Hospital from December 2009 to April 2021.There were 5 males and 3 females in this group with age of(35.2±9.1)years(27⁃45 years).Five patients had a history of ankle fractures,and three patients had ankle varus deformity after metaphyseal injury.Supramalleolar tibial domeshaped osteotomy was used to immediately correct the ankle varus,and then Ilizarov ankle joint external fixator was installed.The ankle joint was drafted to keep joint clearance at 5 mm to 8 mm for walking over 3 months.During the treatment period,the patients can do light weight walking.The clinical treatment effect was evaluated according to the patients distal articular surface angle(TAS)and the American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hind foot function score before and after surgery.Results The follow⁃up time of 8 patients was(31.5±17.9)months(12⁃72 months),and the wearing time of external fixation was(29.4±5.1)weeks(20⁃32 weeks).At the time of removing the external fixation,the osteotomy sites all met the clinical bone healing standards.At the last follow⁃up,the AOFAS score was 82.0±7.7(76⁃90),and the TAS angle was 91.1°±2.4°(89.6°⁃95.0°).Compared with preoperative scores[47.6±3.7(41⁃65),82.9°±4.7°(72°⁃87°)],the difference was statistically significant(P<0.05).All 8 cases experienced local needle infection after surgery,5 cases were wrapped with local alcohol dressing,and 3 cases were controlled after removing the infectious fixing needle.Two cases of broken fixed needles were removed when removing the external fixation device,and there were no other serious complications.Conclusion Supramalleolar domeshaped osteotomy combined with Ilizarov distraction arthroplasty in the treatment of varus ankle osteoarthritis can achieve satisfy correction of ankle valgus deformity,avoid bone graft with internal fixation,and obtain good osteotomy bone healing.Combined use of Ilizarov external fixation and ankle joint distraction allows postoperative full⁃weight walking exercise and significantly improves patientsfoot and ankle function in patients,which is worthy of clinical application.