前侧入路接骨板联合交叉螺钉与后侧入路接骨板行踝关节融合术的疗效比较

Comparison of anterior plate and cross screw versus posterior plate in ankle arthrodesis

目的比较前侧入路接骨板联合交叉螺钉(APCS)与后侧入路接骨板(PP)行踝关节融合术的疗效。方法回顾性分析2017年1月至2021年3月西安交通大学附属红会医院足踝外科收治的终末期踝关节炎患者64例(64足)。男24例,女40例;年龄(57.7±5.5)岁;分期采用Kellgren-Lawrence分级:Ⅲ级25例,Ⅳ级39例。根据手术入路和内固定方式不同将患者分为APCS组(31例,采用APCS固定)和PP组(33例,采用PP固定);通过比较两组患者术前与术后6个月的距骨中心移位(TCM)、矢状面距骨移位(STM),以及术前与末次随访时足踝能力评估量表(FAAM)和疼痛视觉模拟评分(VAS)评估疗效。结果两组患者术前临床基线资料比较差异均无统计学意义(P>0.05),具有可比性。PP组患者术后6个月的STM[(4.45±2.21)mm]显著小于术前[(7.22±4.22)mm],差异有统计学意义(P<0.001)。术后6个月的TCM、STM两组患者间比较,PP组患者术后6个月的TCM与术前比较,APCS组患者术后6个月的TCM、STM与术前比较差异均无统计学意义(P>0.05)。所有患者均获随访,时间为(28.1±6.8)个月。末次随访时FAAM生活评分、FAAM运动评分和疼痛VAS评分两组患者间比较差异均无统计学意义(P>0.05);末次随访时所有患者的FAAM生活评分、FAAM运动评分和疼痛VAS评分均较术前显著改善,差异均有统计学意义(P<0.05)。所有患者中有1例融合失败,发生在APCS组。结论两种融合方式治疗终末期踝关节炎患者都表现出较好的疗效,差别不大,但PP对STM有明显的矫正作用。

ObjectiveTo compare the clinical efficacy between fusion with anterior plate and cross screw(APCS)via the anterolateral approach and that with posterior plate(PP)via the posterior approach in ankle arthrodesis.MethodsA retrospective study was conducted to analyze the 64 patients(64 feet)with end-stage ankle arthritis who had been admitted to Department of Foot and Ankle Surgery,Honghui Hospital of Xi'an Jiaotong University from January 2017 to March 2021.They were 24 males and 40 females with an age of(57.7±5.5)years;by the Kellgren-Lawrence staging,25 cases were in grade Ⅲ and 39 ones in grade Ⅳ.According to the different surgical approaches and internal fixation methods,the patients were divided into a APCS group of 31 cases subjected to the fusion with APCS via the anterolateral approach and a PP group of 33 cases subjected to the fusion with PP via the posterior approach.The clinical efficacy was compared between the 2 groups and between preoperatoion and postoperation in terms of talus center migration(TCM),sagittal talar migration(STM),foot and ankle ability measure(FAAM),and visual analog scale(VAS).ResultsThere was no statistically significant difference in the preoperative baseline data between the 2 groups of patients,indicating comparability(P>0.05).In the PP group,the postoperative STM[(4.45±2.21)]mm was significantly smaller than the postoperative one[(7.22±4.22)]mm(P<0.001).There were no statistically significant differences in the postoperative comparisons of TCM and STM between the 2 groups,in the comparison between postoperative TCM and preoperative TCM in the PP group,or in the comparisons between postoperative and preoperative TCM and STM in the APCS group(P>0.05).All patients were followed up for(28.1±6.8)months.At the last follow-up,there was no statistically significant difference between the 2 groups in the FAAM life score,FAAM exercise score,or VAS pain score(P>0.05).The FAAM life score,FAAM motor score,and VAS pain score at the last follow-up were significantly improved in all the patients compared with the preoperative values(P<0.05).Fusion failure was found in only 1 patient in the APCS group.ConclusionBoth PP and APCS fusion techniques can lead to similarly fine clinical outcomes in ankle arthrodesis,but PP may lead to a significant correction of sagittal talar migration.