微创踝关节融合术在老年创伤性踝关节炎治疗中的应用

Application of minimally invasive ankle arthrodesis in elderly traumatic ankle arthritis and assessment of postoperative trauma and bone metabolism

目的探讨微创踝关节融合术在老年创伤性踝关节炎治疗中的应用。方法选取2014年3月至2015年3月天津市海河医院收治的90例老年创伤性踝关节炎患者,其中采用常规开放式手术治疗45例(对照组),采用微创手术治疗45例(观察组)。两组患者术前均行常规检查,术后均采用石膏固定,第2天拔除引流条,采用抗生素治疗。观察两组患者肌红蛋白(myoglobin,MYO)、缺血修饰白蛋白(ischemia-modified albumin,IMA)、总抗氧化能力(total antioxidant capacity,TAC)、丙二醛(malonaldehyde,MDA),碱性磷酸酶(alkaline phosphates,ALP)、酸性磷酸酶(acid phosphatase,ACP)、甲状旁腺素(acid phosphatase,PTH)、骨钙素(bone gammacarboxyglutamic-acid-containing proteins,BGP)、降钙素(calcitonin,CT)水平,视觉疼痛模拟评分(visual analogue scale/score,VAS)、美国矫形外科足踝协会(american orthopaedic foot and ankle society,AOFAS)评分,不良反应发生情况。组间及组内的比较均采用t检验,计数资料的比较采用χ2检验。结果治疗后,观察组患者MYO、IMA、MDA水平显著低于对照组,TAC显著高于对照组,差异均有统计学意义(t=11.218、4.730、12.930、10.023,均P<0.01);观察组患者ALP、BGP、CT水平均显著高于对照组,ACP、PTH水平显著低于对照组,差异均有统计学意义(t=5.347、10.962、9.731、17.223、13.424,均P<0.01)。治疗前,两组患者VAS、AOFAS评分的差异均无统计学意义(t=0.140、0.583,均P>0.05);治疗后,两组患者VAS评分均显著降低(t=33.372、18.761,均P<0.01),AOFAS评分均显著升高(t=-28.069、-24.653,均P<0.01),差异均有统计学意义;而且观察组VAS评分较对照组更低,AOFAS评分较观察组更高,差异均有统计学意义(t=25.853、6.155,均P<0.01)。观察组患者发生不良反应3例(6.66%),对照组患者发生不良反应10例(22.22%),不良反应发生率的差异有统计学意义(χ~2=4.406,均P<0.05)。结论微创踝关节融合术在老年创伤性踝关节炎中的效果显著,可降低术后创伤,减少不良反应,并能调节骨代谢,保护关节功能,促进术后恢复。

Objective To explore the application of minimally invasive ankle arthrodesis in the treatment of senile traumatic ankle arthritis. Methods From March, 2014 to March, 2015, 90 elderly patients with traumatic ankle arthritis admitted to Haihe Hospital of Tianjin were enrolled. Among them, 45 cases were treated by conventional open surgery(control group) and 45 cases were treated by minimally invasive surgery group). Preoperative two groups of patients underwent routine examination, postoperative gypsums were fixed, the second day removal of drainage strips, the use of antibiotics. Then serum myoglobin oxidative damage index(MYO), ischemia modified albumin(IMA), total antioxidant capacity(TAC), malondialdehyde(MDA) level and bone metabolism index of alkaline phosphatase(ALP), acid phosphatase(ACP), parathyroid hormone(PTH) and Osteocalcin(BGP), calcitonin(CT) levels and the visual analogue scale(VAS), the American Orthopaedic Foot and Ankle Society(AOFAS) score, the incidence of adverse reaction of two groups were compared. T test was used in comparison between groups and groups, and chi-square was used for comparison of counting data. Results After treatment, the levels of MYO, IMA and MDA in the observation group were significantly lower than those in the control group, and the TAC was significantly higher than the control group, the difference was statistically significant(t=11.218, 4.730, 12.930, 10.023, all P < 0.01). In the observation group, ALP, BGP and CT levels were significantly higher than those in the control group, the levels of ACP and PTH were significantly lower than those in the control group, and the differences were statistically significant(t=5.347, 10.962, 9.731, 17.223, 13.424, all P < 0.01). Before treatment, there was no statistically significant difference between VAS and AOFAS scores in both groups(t=0.140, 0.583, all P > 0.05). After treatment, the VAS scores of both groups were significantly reduced(t=33.372, 18.761, all P < 0.01), and the AOFAS scores were significantly higher(t=-28.069,-24.653, all P < 0.01), and the differences were statistically significant. Moreover, the observation group VAS score was lower than the control group, and the AOFAS score was higher than the observation group, and the difference was statistically significant(t=25.853, 6.155, all P < 0.01). In the observation group, adverse reactions occurred in 3 patients(6.66%) and 10 cases(22.22%) in the control group, the difference in the incidence of adverse reactions was statistically significant(χ~2= 4.406, P < 0.05). Conclusion Minimally invasive ankle arthrodesis has a significant effect in the treatment of senile traumatic ankle arthritis, which can reduce postoperative wounds, reduce adverse reactions, increase bone density, regulate bone metabolism, protect joint function and promote postoperative recovery.