CAJ | 학술논문

目的：评估踝后经跟腱正中入路植骨锁定钢板内固定行胫距跟关节融合术的手术技巧和临床效果。方法从2008年1月至2012年12月，共收治123例踝关节合并距下关节创伤性关节炎，其中13例因踝周软组织条件不佳而选用踝关节后方入路胫距、距下关节清理、植骨、4.5 mm干骺端锁定钢板内固定行胫距跟关节融合术。其中男9例，女4例，平均年龄47.8岁（30～65岁）；平均病程7年（1～15年）。术后定期随访复查X线片以明确骨愈合情况，并采用直观模拟量表（ Visual Analog Scale ，VAS）评估术后疼痛改善情况，美国骨科足踝外科（ American Orthopaedic Foot and Ankle Society，AOFAS）踝关节与后足评分及简明健康量表SF-36评分评估恢复效果，并记录相关并发症。结果术后所有患者伤口均一期愈合，未见感染、皮肤坏死等软组织并发症。11例获得最终随访，平均随访时间24个月（12～36个月）。随访复查X线片示术后平均12周融合端骨性愈合（10～15周）。末次随访时，AOFAS踝与后足评分及SF-36评分均较术前明显改善，疼痛症状明显缓解。随访期间未见内固定失效、融合失败等并发症，2例患者术后出现距舟关节骨关节炎，伴轻度疼痛，口服药物对症治疗后缓解。结论经踝后正中入路锁定钢板内固定行胫距跟关节融合安全、有效，特别适合于踝周软组织条件不佳的病例。
목적：평고과후경근건정중입로식골쇄정강판내고정행경거근관절융합술적수술기교화림상효과。방법종2008년1월지2012년12월，공수치123례과관절합병거하관절창상성관절염，기중13례인과주연조직조건불가이선용과관절후방입로경거、거하관절청리、식골、4.5 mm간후단쇄정강판내고정행경거근관절융합술。기중남9례，녀4례，평균년령47.8세（30～65세）；평균병정7년（1～15년）。술후정기수방복사X선편이명학골유합정황，병채용직관모의량표（ Visual Analog Scale ，VAS）평고술후동통개선정황，미국골과족과외과（ American Orthopaedic Foot and Ankle Society，AOFAS）과관절여후족평분급간명건강량표SF-36평분평고회복효과，병기록상관병발증。결과술후소유환자상구균일기유합，미견감염、피부배사등연조직병발증。11례획득최종수방，평균수방시간24개월（12～36개월）。수방복사X선편시술후평균12주융합단골성유합（10～15주）。말차수방시，AOFAS과여후족평분급SF-36평분균교술전명현개선，동통증상명현완해。수방기간미견내고정실효、융합실패등병발증，2례환자술후출현거주관절골관절염，반경도동통，구복약물대증치료후완해。결론경과후정중입로쇄정강판내고정행경거근관절융합안전、유효，특별괄합우과주연조직조건불가적병례。
Objective To evaluate the surgical technique and clinical outcomes of the tibiotalocalcaneal ( TTC) arthrodesis using the posterior midline approach with the locking plates .Methods From Jan 2008 to Dec 2012, 123 cases of the post-traumatic arthritis of the ankle joint and subtalar joint were treated in our department , 13 of which underwent the tibiotalocalcaneal arthrodesis via a direct posterior midline approach because of the compromised soft tissue around the ankle .This technique used the well vascularized, thick, posterior soft tissue envelope , to provide a very good exposure of the articular surface for debridement.The bone graft and the TTC fusion were performed with a 4.5mm locking plate. There were nine cases of men and four cases of women with a mean age of 47.8 years old (30-65 years old).The average course of the disease was 7 years (1-15 years).Regular X-rays were taken during the follow-up for the confirmation of the bone healing .The outcomes were assessed by a combination of pre-and post-operative clinical examinations , including AOFAS hind foot score , VAS score and SF-36 score.The complications were also recorded . Results All wounds were primary healing and no soft tissue complication such as infection , skin necrosis was occurred .11 patients got final follow-up with a mean follow-up time of 24 months (12-36 months).The follow-up X-ray demonstrated the bone healing in the 12th week (10th -15th week) post-operatively on average.The AOFAS hind foot and ankle scores were improved and the pain was relieved significantly at the final follow-up.There was no complication of implant failure or fusion failure during the follow-up.Two cases suffered from mild pain because of the talonavicular arthritis post-operatively , which was relieved by conservative treatment .Conclusion The posterior midline approach with locking plate fixation is a safe and effective treatment for TTC fusion with compromised soft tissue around the ankle .