踝关节置换术治疗终末期创伤性踝关节炎的疗效分析

Efficacy of total ankle arthroplasty in the treatment of end-stage post-traumatic ankle arthritis

目的探讨踝关节置换术(TAA)治疗终末期创伤性踝关节炎的疗效。方法回顾性分析2014年1月至2022年12月西安交通大学附属红会医院足踝外科诊疗中心接受TAA治疗的41例(41踝)终末期创伤性踝关节炎患者资料。男19例,女22例;年龄(58.5±8.9)岁;体重指数(23.6±2.3)kg/m 2;左踝17例,右踝24例。比较患者术前、末次随访时的美国足踝外科协会(AOFAS)踝-后足评分、疼痛视觉模拟评分(VAS)、健康评估12项简表(SF-12)、后足力线(HFA)角、踝关节活动度(ROM),并观察并发症的发生情况。结果41例患者术后均获随访,时间(52.2±10.9)个月。本组患者末次随访时的AOFAS踝-后足评分(85.1±4.8)分、疼痛VAS评分1.0(0.5,1.0)分、SF-12生理得分(46.9±3.9)分、SF-12心理得分(53.9±2.0)分、HFA角0.1°±4.3°、踝关节活动度39.0°±5.1°均较术前[(45.8±8.2)分、6.0(5.0,6.5)分、(27.9±3.1)分、(49.6±4.0)分、-6.8°±13.9°、20.5°±4.6°]显著改善,差异均有统计学意义(P<0.05)。术后12例患者发生并发症,其中主要为踝关节周围疼痛(6例),还有伤口愈合不良、骨囊肿、足背外侧麻木或感觉异常、术中截骨骨折,随访期间无翻修病例。结论TAA是治疗终末期创伤性踝关节炎的有效手段,能显著缓解患者的踝关节疼痛,并保留部分踝关节活动功能。

ObjectiveTo investigate the efficacy of total ankle arthroplasty(TAA)in the treatment of end-stage post-traumatic ankle arthritis.MethodsA retrospective analysis was conducted of the clinical data of 41 patients(41 ankles)who had been treated from January 2014 to December 2022 at Foot and Ankle Surgery Department,Honghui Hospital of Xi'an Jiaotong University for end-stage post-traumatic ankle arthritis with TAA.There were 19 males and 22 females with an age of(58.5±8.9)years and a body mass index of(23.6±2.3)kg/m 2;17 left ankles and 24 right ankles were involved.The quantitative measures like the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score,visual analogue scale(VAS)pain score,and the Health Survey Scoring Demonstration Short Form-12(SF-12),hindfoot alignment(HFA),and ankle range of motion(ROM)were compared between preoperation and the final follow-up to evaluate the efficacy.The incidence of postoperative complications were observed.ResultsThe 41 patients were followed up postoperatively for(52.2±10.9)months.At the last follow-up,the AOFAS ankle-hindfoot score(85.1±4.8),VAS pain score 1.0(0.5,1.0),SF-12 Physical Component Summary score(46.9±3.9),SF-12 Mental Component Summary score(53.9±2.0),HFA angle(0.1°±4.3°),and ankle ROM(39.0°±5.1°)were significantly improved compared with the preoperative values[45.8±8.2,6.0(5.0,6.5),27.9±3.1,49.6±4.0,-6.8°±13.9°,and 20.5°±4.6°](all P<0.05).Postoperatively,12 patients experienced complications,like mostly ankle periarticular pain(6 cases),poor wound healing,bone cysts,dorsolateral foot numbness or sensory abnormality,and intraoperative osteotomy fracture.No case needed revision during the follow-up period.ConclusionTAA is an effective treatment of end-stage post-traumatic ankle arthritis,because it can significantly alleviate ankle pain and preserve mobility of the ankle joint to some extent.