中国修复重建外科杂志

中国修复重建外科杂志

联合小切口下全螺纹无头加压螺钉行胫-距-跟融合术疗效分析

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目的探讨采用联合小切口下全螺纹无头加压螺钉行胫-距-跟融合术的临床疗效。方法2012 年 1 月—2016 年 12 月,对 36 例(36 足)踝关节疾病患者采用联合前踝正中纵切口及外踝跗骨窦小切口下 2 枚全螺纹无头加压螺钉加压固定行胫-距-跟融合术治疗。男 14 例,女 22 例;年龄 18~76 岁,平均 53.8 岁。左足 19 例,右足 17 例。距骨塌陷性坏死 21 例,创伤性关节炎 7 例,类风湿性关节炎 3 例,结核感染(非活动性)2 例,距骨缺如 1 例, Charcot 关节病 1 例,踝及距下关节绒毛结节性滑膜炎 1 例。术前美国矫形足踝协会(AOFAS)评分为(53.7±2.5)分,疼痛视觉模拟评分(VAS)为(5.9±0.2)分。记录手术时间、术后患者切口愈合以及并发症发生情况,X 线片及 CT 检查关节面是否达骨性融合,AOFAS 评分和 VAS 评分评价关节功能及疼痛情况。结果手术时间 33~82 min,平均 49.8 min。术后 3 周 1 例(2.8%)发生切口皮肤感染,经清创、换药后痊愈;其余患者切口均Ⅰ期愈合,无相关并发症发生。术后 35 例患者获随访,随访时间 12~29 个月,平均 18.5 个月。影像学检查示均达骨性融合,融合时间 8~15 周,平均 10.9 周。术后 1 年,AOFAS 评分为(84.7±0.6)分,VAS 评分为(0.3±0.1)分,与术前比较差异均有统计学意义(t=12.596,P=0.000;t=30.393,P=0.000)。结论采用联合小切口下全螺纹无头加压螺钉固定行胫-距-跟融合术具有并发症少、术后融合率高等特点,是治疗踝关节终末期疾病有效术式。

ObjectiveTo investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions.MethodsBetween January 2012 and December 2016, 36 patients (36 feet) with ankle diseases underwent tibio-talo-calcaneal arthrodesis with parallel double thread headless compression screws via minimal anterior and lateral oblique incisions. There were 14 males and 22 females with an average age of 53.8 years (range, 18-76 years). There were 19 cases of left feet and 17 cases of right feet. There were 21 cases of talar necrosis, 7 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 2 cases of tuberculosis infection (inactive), 1 case of talar absence, 1 case of Charcot’s disease, and 1 case of pigmented villonodular synovitis of ankle and subtalar joints. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 53.7±2.5 and 5.9±0.2, respectively. The operation time was recorded and the wound healing and complications were observed. The bone healing was assessed by X-ray film and CT scanning. The function and pain of joint were evaluated by AOFAS and VAS scores.ResultsThe mean operation time was 49.8 minutes (range, 33-82 minutes). Incision infection occurred in 1 patient (2.8%) at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of 18.5 months (range, 12-29 months). Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks (range, 8-15 weeks). After 1 year, the AOFAS score (84.7±0.6) and VAS score (0.3±0.1) were significantly higher than preoperative scores (t=12.596, P=0.000; t=30.393, P=0.000).ConclusionIt is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle disease because of the less complications incidence and the higher postoperative fusion rate.

关键词: 胫-距-跟融合术; 踝关节; 距下关节; 全螺纹无头加压螺钉; 小切口

Key words: Tibio-talo-calcaneal arthrodesis; ankle; subtalar; full thread headless compression screw; minimal incision

引用本文: 杨明宇, 谢美明, 龚继承, 周兵华, 穆米多, 陈雍华, 唐康来. 联合小切口下全螺纹无头加压螺钉行胫-距-跟融合术疗效分析. 中国修复重建外科杂志, 2018, 32(10): 1297-1301. doi: 10.7507/1002-1892.201806048 复制

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