CAJ | 학술논문

目的探讨经皮空心螺钉加压固定踝关节融合术的临床疗效。方法2005年4月至2010年10月，12例单侧严重踝关节炎患者(Kellgren-LawrenceⅢ级)接受经皮空心螺钉加压固定踝关节融合术。男7例，女5例；年龄25～71岁，平均42.0岁。病程1～21年，平均7.3年。类风湿关节炎2例，创伤性关节炎8例，骨关节炎2例。取踝关节前正中人路，暴露踝关节腔，完整去除胫距关节软骨面，暴露软骨下骨。从后上向前下经皮穿针，以空心螺钉加压固定胫距关节。手术前后采用美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society，AOFAS)踝-后足功能评分进行功能评定，摄踝关节正侧位及踝穴位X线片观察踝关节骨性融合情况。结果12例患者均得到随访，随访时间6～55个月，平均21.5个月。AOFAS踝-后足功能评分由术前(42.8±8.6)分增加至术后6个月(66.6±5.4)分，差异有统计学意义(t=-3.075,P=0.012)；末次随访(72.3±4.6)分，与术前比较差异有统计学意义(t=-8.595，P=0.006)。X线片证实全部病例均骨性融合，融合时间9～21周，平均13.5周。无感染，无局部皮肤坏死，无螺钉松动、退钉及断钉。结论经皮空心螺钉加压固定踝关节融合术创伤小，融合率高，融合时间短，近期疗效满意，并发症少。
목적탐토경피공심라정가압고정과관절융합술적림상료효。방법2005년4월지2010년10월，12례단측엄중과관절염환자(Kellgren-LawrenceⅢ급)접수경피공심라정가압고정과관절융합술。남7례，녀5례；년령25～71세，평균42.0세。병정1～21년，평균7.3년。류풍습관절염2례，창상성관절염8례，골관절염2례。취과관절전정중인로，폭로과관절강，완정거제경거관절연골면，폭로연골하골。종후상향전하경피천침，이공심라정가압고정경거관절。수술전후채용미국족과외과의사협회(American Orthopaedic Foot and Ankle Society，AOFAS)과-후족공능평분진행공능평정，섭과관절정측위급과혈위X선편관찰과관절골성융합정황。결과12례환자균득도수방，수방시간6～55개월，평균21.5개월。AOFAS과-후족공능평분유술전(42.8±8.6)분증가지술후6개월(66.6±5.4)분，차이유통계학의의(t=-3.075,P=0.012)；말차수방(72.3±4.6)분，여술전비교차이유통계학의의(t=-8.595，P=0.006)。X선편증실전부병례균골성융합，융합시간9～21주，평균13.5주。무감염，무국부피부배사，무라정송동、퇴정급단정。결론경피공심라정가압고정과관절융합술창상소，융합솔고，융합시간단，근기료효만의，병발증소。
Objective To evaluate the clinical results of minimally invasive ankle arthrodesis with percutaneous cannulated screws. Methods Between April 2005 and October 2010, 12 patients with the ankle arthrodesis for unilateral severe arthritis (Kellgren-Lawrence class Ⅲ) were prospectively analyzed, including 2 cases of rheumatoid arthritis, 8 cases of post-traumatic arthritis, and 2 cases of osteoarthritis. There were 7 males and 5 females with an average age of 42.0 years (range, 25-7 1). The average disease duration was 7.3 years (range, 1-21). The anterior median incision of 3.0-5.0 cm was made to explore the ankle joint.The cartilage of tibial-talus joint was completely debrided. Two guide pins were inserted from posterosuperior to anteroinferior, and cannulated screws were implanted to fix ankle joint. All patients were physically examined with an extended protocol of questionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Scales. Ankle fusion in all patients was evaluated by clinical examination, and conventional radiography including anterior-posterior, lateral and mortise views of the ankle. Results All 12 patients were followed up postoperatively for an average of 21.5 months (range, 6-55), and were proved be bone union by clinical examination and radiology with a mean of 13.5 weeks (range, 9-21). The AOFAS rating scale improved from a mean of 42.8±8.6 points at pre-operation to a mean of 66.6±5.4 points at post-operation 6 months,showing significant difference (t=-3.075, P=O.012), and to a mean of 72.3±4.6 at the final follow-up, also showing significant difference with pre-operation (t=-8.595, P=-0.006). There was no infection,local skin necrosis, screw loosing, and so on. Conclusion The minimally invasive ankle arthrodesis with percutaneous cannulated scews is a recommend procedure, with mini-invasion, short surgery time, high fusion rate, good clinical outcomes, few complications.