胫距跟关节融合术中钢板与髓内钉固定的疗效比较

Comparison of Plating and Intramedullary Nail for Tibiotalocalcaneal Arthrodesis

目的比较胫距跟关节融合时应用前路锁定钢板与逆行髓内钉固定的疗效。方法回顾性分析2018年6月至2022年12月南京医科大学附属逸夫医院行胫距跟关节融合术治疗的43例患者资料。其中男20例,女23例;年龄36~74岁,平均(59.0±7.5)岁;左侧20例,右侧23例。24例行前路锁定钢板内固定术(钢板组),19例行逆行髓内钉内固定术(髓内钉组)。比较两种固定方法的手术时间、术中出血量、住院费用、骨性融合率、骨性融合时间、术后并发症、美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足功能评分和简明健康调查问卷(the mos item short form health survey,SF-36)评分。结果钢板组术中出血量(78.3±23.5)mL,髓内钉组术中出血量(84.2±21.7)mL。患者均随访12~22个月,平均(15.8±2.4)个月。随访期间钢板组、髓内钉组患者骨性融合率分别为95.8%(23/24)、94.7%(18/19)。术后钢板组出现1例软组织感染,1例软组织感染和骨不连,1例皮下软组织激惹症状;髓内钉组出现1例骨不连。术后并发症发生率钢板组12.5%(3/24),髓内钉组5.3%(1/19),差异无统计学意义(P>0.05)。钢板组和髓内钉组手术时间分别为(103.3±16.9)min和(115.0±15.3)min;住院费用分别为(40286.8±5162.7)元和(53314.7±6031.6)元;骨性融合时间分别为(4.7±0.5)个月、(4.4±0.4)个月;两组术后6个月随访时AOFAS踝-后足评分分别为(65.7±4.8)分、(69.8±7.3)分,SF-36评分分别为(68.5±8.8)分、(73.4±5.5)分,以上比较,两组间差异均有统计学意义(P<0.05),但末次随访时两组AOFAS踝-后足评分和SF-36评分比较,差异无统计学意义(P>0.05)。结论胫距跟关节融合术中,逆行髓内钉固定较前路锁定钢板固定手术时间长,但骨性融合时间短,术后早期髓内钉较前路锁定钢板固定疗效更优,但最终两组均可获得良好的临床效果。

Objective To compare the clinical effects between anterior locking plate fixation and retrograde intramedullary nail fixation in tibiotalocalcaneal arthrodesis.Methods A retrospective analysis was conducted on medical records of 43 patients who underwent tibiotalocalcaneal arthrodesis at the Sir Run Run Shaw Hospital,Nanjing Medical University between June 2018 and December 2022.There were 20 males and 23 females,aged 36 to 74 years,with an average age of(59.0±7.5)years.Twenty cases involved the left limb,and 23 cases involved the right limb.24 patients were treated with locking plate fixation(Anterior Locking Plate Group)and 19 patients were treated with retrograde intramedullary nail fixation(Intramedullary Nail Group).The two fixation methods were compared in terms of operation time,intraoperative blood loss,hospitalization expenses,bony union rate,bony union time,postoperative complications,American orthopaedic foot and ankle society(AOFAS)ankle-hindfoot scale scores,and short form 36(SF-36)scores.Results The Anterior Locking Plate Group had an average intraoperative blood loss of(78.3±23.5)mL,while the Intramedullary Nail Group had(84.2±21.7)mL.All patients were followed up for 12 to 22 months,with an average of(15.8±2.4)months.The bony union rates for the Anterior Locking Plate Group and Intramedullary Nail Group were 95.8%(23/24)and 94.7%(18/19),respectively.Complications arose in both groups:The Anterior Locking Plate Group experienced 1 case of soft tissue infection,1 case of both soft tissue infection and nonunion,and 1 case of soft tissue irritation;the Intramedullary Nail Group had 1 case of nonunion.The incidence of postoperative complications was 12.5%(3/24)for the Anterior Locking Plate Group and 5.3%(1/19)for the Intramedullary Nail Group,with no statistically significant difference(P>0.05).The operation time for the Anterior Locking Plate Group and Intramedullary Nail Group were(103.3±16.9)minutes and(115.0±15.3)minutes,respectively;hospitalization expenses were(40286.8±5162.7)and(53314.7±6031.6),respectively;the bony fusion times were(4.7±0.5)months and(4.4±0.4)months,respectively;the AOFAS ankle-hindfoot scale scores at six months postoperatively were(65.7±4.8)points and(69.8±7.3)points,respectively;the SF-36 scores were(68.5±8.8)points and(73.4±5.5)points,respectively,with significant differences(P<0.05).However,at the final follow-up,there were no significant differences in AOFAS ankle-hindfoot scores or SF-36 scores(P>0.05).Conclusion In tibiotalocalcaneal arthrodesis,anterior locking plate fixation resulted in shorter operation time compared to intramedullary nail fixation,but the bony union time was longer.While intramedullary nail fixation demonstrated better clinical effects in the early postoperative period,both methods ultimately achieved good clinical effects.