CAJ | 학술논문

目的探讨和评价踝关节周围截骨矫正术治疗踝关节炎的指征、方法和疗效.方法 2005年2月至2011年5月,采用踝关节周围截骨手术治疗65例踝关节炎患者.女43例,男22例；年龄35～74岁,平均55.5岁.Takakura踝关节炎分级:2级29例,3级32例,4级4例.接受单纯踝上胫骨截骨20例,踝上胫腓骨截骨12例,踝上胫骨截骨合并跟骨截骨30例,踝上胫腓骨截骨合并跟骨截骨3例.合并行三关节融合术者3例,距舟关节融合术者2例,第一跖骨基底截骨术者4例.对43例患者施行踝关节内外侧软组织松解和韧带重建手术.比较患者手术前后正、侧位X线片上胫骨前面角(tibial anterior surface angle,TAS)和胫骨侧面角(tibial lateral surface angle,TLS)差异.应用美国足踝医师协会后足与踝关节评分(AOFAS-HA评分)对患者手术前后功能情况进行评价.结果 59例患者获得平均35.7个月(7～94个月)随访.所有患者均达到骨性愈合,平均骨愈合时间为7～8周.AOFAS评分自术前平均49.7分提高到术后12个月时的平均78.6分.TAS术前平均86.1°,术后6个月平均93.9°.TLS不正常者5例,术前平均70.0°,术后6个月时平均81.5°.5例患者术后发生切口延迟愈合,经伤口护理后愈合.42例患者对手术效果表示非常满意,15例患者比较满意,2例患者满意度一般.结论踝关节周围截骨术治疗非对称性踝关节炎有效,选择合适指征的患者,能够减轻病变处关节软骨的负荷,延长自身关节的使用时间.
목적 탐토화평개과관절주위절골교정술치료과관절염적지정、방법화료효.방법 2005년2월지2011년5월,채용과관절주위절골수술치료65례과관절염환자.녀43례,남22례；년령35～74세,평균55.5세.Takakura과관절염분급:2급29례,3급32례,4급4례.접수단순과상경골절골20례,과상경비골절골12례,과상경골절골합병근골절골30례,과상경비골절골합병근골절골3례.합병행삼관절융합술자3례,거주관절융합술자2례,제일척골기저절골술자4례.대43례환자시행과관절내외측연조직송해화인대중건수술.비교환자수술전후정、측위X선편상경골전면각(tibial anterior surface angle,TAS)화경골측면각(tibial lateral surface angle,TLS)차이.응용미국족과의사협회후족여과관절평분(AOFAS-HA평분)대환자수술전후공능정황진행평개.결과 59례환자획득평균35.7개월(7～94개월)수방.소유환자균체도골성유합,평균골유합시간위7～8주.AOFAS평분자술전평균49.7분제고도술후12개월시적평균78.6분.TAS술전평균86.1°,술후6개월평균93.9°.TLS불정상자5례,술전평균70.0°,술후6개월시평균81.5°.5례환자술후발생절구연지유합,경상구호리후유합.42례환자대수술효과표시비상만의,15례환자비교만의,2례환자만의도일반.결론 과관절주위절골술치료비대칭성과관절염유효,선택합괄지정적환자,능구감경병변처관절연골적부하,연장자신관절적사용시간.
Objective To evaluate effect of periarticular osteotomy in the treatment of asymmetrical ankle arthritis.Methods Sixty-five patients with asymmetrical ankle arthritis were treated with periarticular osteotomy between February 2005 and May 2011,including 43 females and 22 males,aged from 35 to 74 years (mean,55.5 years).According to the Takakura classification of ankle arthritis,there were 29 patients in grade 2,32 in grade 3 and 4 in grade 4.Supramalleolar tibial osteotomy were performed in 20 patients,supramalleolar tibial and fibular osteotomy in 12,supramalleolar osteotomy combined with calcaneal osteotomy in 30 patients,and supramalleolar tibial and fibular osteotomy combined with calcaneal osteotomy in 3patients.Forty three patients underwent ligament reconstruction procedures.Based on radiographs,the tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were compared before and after operation.AOFAS-AH score was used to evaluate the function of the ankle.Results Fifty-nine patients were followed up for an average of 35.7 months (range,7 to 94 months).Bone healing was observed in all patients,and the average healing time was 7 to 8 weeks.The average AOFAS-AH score was improved from 49.7 points preoperatively to 78.6 points 12 months postoperatively.Tbe average TAS and TLS was improved from 86.1° and 70.0° preoperatively to 93.9° and 81.5° 6 months postoperatively,respectively.Delayed wound healing occurred in 5 patients,which was resovled after nursing care.Forty-two patients felt excellent about results,15 felt good and 2 fell fair.Conclusion Perarticular osteotomy is a sound method in the treatment of asymmetrical ankle arthritis,based on chosing proper patients.The procedure can decrease the contact pressures on the degenerated cartilage and prolong the life span of the ankle.