CAJ | 학술논문

目的观察踝上截骨术治疗踝关节2期创伤性关节炎的疗效.方法自2005年10月至2008年5月对47例踝火节2期创伤性关节炎行踝上截骨术治疗,31例获得完整随访.12例行开放性楔形截骨术,其中10例胫骨内侧开放件楔形截骨术即时矫正踝关节内翻,此间有3例在即时矫正内翻的同时行跗管松解术,2例因踝关节严重内翻畸形愈合,截骨同时在Ilizarov治疗器下缓慢牵张矫正原始畸形愈合;19例行腓骨退旋延长术.采用美国骨科足踝外科协会(AOFAS)踝关节功能评分系统进行评分.结果 31例获得12～43个月(平均27.3个月)随访.骨折全部愈合,临床愈合时间平均为13.3周(11～17周),完全负重时间平均为14.1周(12～19周).术后12个月踝火节AOFAS评分为63～92分,平均84.3分,其中优14例,良11例,一般6例,优良率80.6%.术后2例出现内侧切口裂开,1例发生内侧切口皮缘部分坏死,均经换药保守治疗痊愈.3例术后出现足外侧皮肤感觉麻木,2例患者在最近随访时X线片示关节炎有轻微进展,予以关节腔注射施沛特保守治疗后而无需手术即获得了满意的临床效果.无螺钉松动、断裂及内固定失效等其他并发症.结论采用踝上截骨术治疗踝关节2期创伤性关节炎,近期可获得满意效果.
목적 관찰과상절골술치료과관절2기창상성관절염적료효.방법 자2005년10월지2008년5월대47례과화절2기창상성관절염행과상절골술치료,31례획득완정수방.12례행개방성설형절골술,기중10례경골내측개방건설형절골술즉시교정과관절내번,차간유3례재즉시교정내번적동시행부관송해술,2례인과관절엄중내번기형유합,절골동시재Ilizarov치료기하완만견장교정원시기형유합;19례행비골퇴선연장술.채용미국골과족과외과협회(AOFAS)과관절공능평분계통진행평분.결과 31례획득12～43개월(평균27.3개월)수방.골절전부유합,림상유합시간평균위13.3주(11～17주),완전부중시간평균위14.1주(12～19주).술후12개월과화절AOFAS평분위63～92분,평균84.3분,기중우14례,량11례,일반6례,우량솔80.6%.술후2례출현내측절구렬개,1례발생내측절구피연부분배사,균경환약보수치료전유.3례술후출현족외측피부감각마목,2례환자재최근수방시X선편시관절염유경미진전,여이관절강주사시패특보수치료후이무수수술즉획득료만의적림상효과.무라정송동、단렬급내고정실효등기타병발증.결론 채용과상절골술치료과관절2기창상성관절염,근기가획득만의효과.
Objective To investigate the therapeutic effects of supramalleolar ostentomv for secondary traumatic arthritis of the ankle joint Methods Forty-seven patients with secondary traumatic arthritis of theankle joint were admitted to our hospital from October 2005 to May 2008.Only 31 patients of them who had been available to complete follow-up were included in this study.Ofthem,12 underwent open wedge-shaped osteotomy and theother 19 thelengtheningosteotomy of the fibula.Inopenwedge-shapedosteotomy,10 caseshad correction of the varus deformity of the ankle instantly during the operation,3 of whomalso received the releasing of tarsal tunnel at the sametime,whilethe other 2 ankles were treated with the Ilizarov external fixator to correct the malformation gradually due to severe varns deformity.The functions of the ankle were assessed by the American Orthopaedic Foot&Ankle Society(AOFAS)scoring system Results Ameanfollow-up of 27.3(12to43)months showed that all the fractures were healed in a mean time of 13.3(11 to 17)weeks Themean time for total weight-bearing was 14.1(12to 19)weeks.The mean AOFAS score of the ankle function 12 months after the operation was 84.3.There were 14excellent cases,11 good and 6 fair ones(good to excellent rate:80.6%).After the operation,2 patients had wound disruption and 1 patient skin necrosis around the wound.Anaesthesia on the lateral side of the foot happened in 3 patients,and a slightly aggravated degeneration of the ankle joint in 2 patients.All complications responded to conservative managements.No failure of the internal fixation was noted in this group. Conclusion Supramaileolar osteotomy can lead to a good outcome in the early postoperative period for the secondary Iraumatic arthritis of the ankle joint.