微骨折技术应用于关节镜下踝关节融合术

Microfracture technique in arthroscopic ankle arthrodesis for severe ankle arthritis

[目的]探讨微骨折技术应用于关节镜下踝关节融合术的临床疗效,尤其是伴有踝关节内外翻畸形时,能否通过微骨折技术提升踝关节融合率,避免关节内植骨。[方法]回顾分析2011年1月～2017年12月本科关节镜下踝关节融合术治疗的终末期关节炎患者48例。依据术前站立位踝关节正位X线片测量胫距关节面夹角,将内外翻角度在10°～20°的19例患者分为A组,将10°以内的29例患者分为B组。常规进行关节镜下踝关节融合术,术中应用微骨折技术,比较两组术后踝关节骨性融合时间和美国足踝外科学会踝-后足评分(AOFAS)等评估指标。[结果]术后2例患者出现足背前外侧感觉麻木,术后6周缓解,术后3个月感觉恢复。48例患者平均随访(25.60±7.87)个月,术后12周复查X线片提示A组患者骨性融合率与B组相比差异有统计学意义(P<0.05)。术后两组病例均达到骨性融合,但两组融合时间差异有统计学意义(P<0.05)。术后末次随访时两组AOFAS评分差异无统计学意义(P>0.05)。[结论]对于胫距关节面夹角内外翻在10°～20°的终末期踝关节炎患者,在关节镜辅助下踝关节融合术中应用微骨折技术可避免关节内植骨,近期临床疗效满意,但对于踝关节内外翻畸形明显时,骨性融合时间会延长。

[Objective] To investigate the clinical efficacy of microfracture technique in arthroscopic ankle arthrodesis for end-stage ankle arthritis, and to explore whether it could improve the fusion and avoid bone graft, especially for the patients with obvious ankle deformity. [Methods] A retrospective study was conducted on 48 patients who underwent arthroscopic ankle arthrodesis for end-stage arthritis in our department from Jan 1, 2011 to Dec 31, 2017. Based on the tibiotalar angle measured by weight-bearing radiographs, 19 patients with the deformity angle ranged 10°~20° were termed as Group A, while the remaining 29 patients who had the angle less than 10° were named as Group B. The conventional arthroscopic ankle arthrodesis combined with microfracture was performed in all the patients. The fusion time revealed by radiographs and American Orthopedic Foot and Ankle Society(AOFAS) scores were compared between the two groups. [Results] After operation, 2 patients felt numb on the lateral dorsal side, which relieved after 6 weeks and totally recovered 3 months later without specific treatment. The 48 patients were followed up for(25.60±7.87) months on average. At 12 weeks postoperatively, the Group A had significantly lower fusion rate revealed by radiographs than the Group B with a statistically significant difference between them(P<0.05). In addition, the Group A took significantly longer time elapsed for bony fusion than the Group B(P<0.05), despite of the fact that bony fusion achieved eventually in all the 48 patients. However, there was no significant difference between the two groups regarding to the AOFAS score at the latest follow-up(P>0.05). [Conclusion] The microfracture is an effective technique to improve ankle fusion without bone graft in arthroscopic arthrodesis for the end-stage ankle arthritis, especially for the patients with varus and valgus deformities ranged 10°~20°. However, as the deformity become obvious, the bone fusion is time-delayed.