中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2013年
4期
409-413
,共5页
目的 探讨踝关节融合治疗创伤后踝关节炎的早期临床疗效.方法 回顾性分析2008年1月至2012年5月,采用踝关节融合治疗并获得随访的47例创伤后踝关节炎患者资料,男28例,女19例；年龄14～72岁,平均44岁；均为Morrey-Wiedeman 3期踝关节炎,其中17例合并距下关节炎；31例有明显足内外翻畸形或马蹄足畸形,16例外观大致正常.采用Kofoed踝关节评分、美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分、Maryland足部评分及视觉模拟评价(visual analogue scale,VAS)评价术前及末次随访时足踝关节功能.结果 47例患者均获得随访,随访时间为5～52个月,平均25个月.末次随访时踝关节均融合,其中1例术后出现感染,经去除内固定及清创后踝关节融合.43例主观满意度为非常满意或满意,4例为一般,满意率为91.5％ (43/47).Kofoed评分,末次随访时平均为(80.96±6.07)分,与术前(48.11±5.00)分比较,差异有统计学意义；AOFAS评分,末次随访时平均为(82.21±4.26)分,与术前(53.38±5.52)分比较,差异有统计学意义；Maryland 评分,末次随访时平均为(88.94±5.14)分,与术前(49.74±5.71)分比较,差异有统计学意义；VAS评分,末次随访时平均为(2.28±1.10)分,与术前(7.89±0.87)分比较,差异有统计学意义.踝关节正位X线片中,22例踝融合于中立位,19例外翻＜5°,3例外翻5°～10°,2例内翻＜5°,1例内翻5°～10°；侧位X线片中,32例踝融合于背伸中立位,12例跖屈5°以内,3例跖屈5°～10°.结论 踝关节融合治疗严重的创伤后踝关节炎早期即可纠正畸形、缓解疼痛与重建功能,是治疗创伤后踝关节炎的良好选择.
目的 探討踝關節融閤治療創傷後踝關節炎的早期臨床療效.方法 迴顧性分析2008年1月至2012年5月,採用踝關節融閤治療併穫得隨訪的47例創傷後踝關節炎患者資料,男28例,女19例；年齡14～72歲,平均44歲；均為Morrey-Wiedeman 3期踝關節炎,其中17例閤併距下關節炎；31例有明顯足內外翻畸形或馬蹄足畸形,16例外觀大緻正常.採用Kofoed踝關節評分、美國足踝外科協會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與後足評分、Maryland足部評分及視覺模擬評價(visual analogue scale,VAS)評價術前及末次隨訪時足踝關節功能.結果 47例患者均穫得隨訪,隨訪時間為5～52箇月,平均25箇月.末次隨訪時踝關節均融閤,其中1例術後齣現感染,經去除內固定及清創後踝關節融閤.43例主觀滿意度為非常滿意或滿意,4例為一般,滿意率為91.5％ (43/47).Kofoed評分,末次隨訪時平均為(80.96±6.07)分,與術前(48.11±5.00)分比較,差異有統計學意義；AOFAS評分,末次隨訪時平均為(82.21±4.26)分,與術前(53.38±5.52)分比較,差異有統計學意義；Maryland 評分,末次隨訪時平均為(88.94±5.14)分,與術前(49.74±5.71)分比較,差異有統計學意義；VAS評分,末次隨訪時平均為(2.28±1.10)分,與術前(7.89±0.87)分比較,差異有統計學意義.踝關節正位X線片中,22例踝融閤于中立位,19例外翻＜5°,3例外翻5°～10°,2例內翻＜5°,1例內翻5°～10°；側位X線片中,32例踝融閤于揹伸中立位,12例蹠屈5°以內,3例蹠屈5°～10°.結論 踝關節融閤治療嚴重的創傷後踝關節炎早期即可糾正畸形、緩解疼痛與重建功能,是治療創傷後踝關節炎的良好選擇.
목적 탐토과관절융합치료창상후과관절염적조기림상료효.방법 회고성분석2008년1월지2012년5월,채용과관절융합치료병획득수방적47례창상후과관절염환자자료,남28례,녀19례；년령14～72세,평균44세；균위Morrey-Wiedeman 3기과관절염,기중17례합병거하관절염；31례유명현족내외번기형혹마제족기형,16예외관대치정상.채용Kofoed과관절평분、미국족과외과협회(American Orthopaedic Foot and Ankle Society,AOFAS)과여후족평분、Maryland족부평분급시각모의평개(visual analogue scale,VAS)평개술전급말차수방시족과관절공능.결과 47례환자균획득수방,수방시간위5～52개월,평균25개월.말차수방시과관절균융합,기중1례술후출현감염,경거제내고정급청창후과관절융합.43례주관만의도위비상만의혹만의,4례위일반,만의솔위91.5％ (43/47).Kofoed평분,말차수방시평균위(80.96±6.07)분,여술전(48.11±5.00)분비교,차이유통계학의의；AOFAS평분,말차수방시평균위(82.21±4.26)분,여술전(53.38±5.52)분비교,차이유통계학의의；Maryland 평분,말차수방시평균위(88.94±5.14)분,여술전(49.74±5.71)분비교,차이유통계학의의；VAS평분,말차수방시평균위(2.28±1.10)분,여술전(7.89±0.87)분비교,차이유통계학의의.과관절정위X선편중,22례과융합우중립위,19예외번＜5°,3예외번5°～10°,2례내번＜5°,1례내번5°～10°；측위X선편중,32례과융합우배신중립위,12례척굴5°이내,3례척굴5°～10°.결론 과관절융합치료엄중적창상후과관절염조기즉가규정기형、완해동통여중건공능,시치료창상후과관절염적량호선택.
Objective To explore the short-term clinical outcomes of ankle arthrodesis for the treatment of posttraumatic ankle arthritis.Methods Retrospectively study the data of 47 patients with posttraumatic ankle arthritis who were followed up after receiving ankle arthrodesis from January 2008 to May 2012.There were 28 males and 19 females,with an average age of 44 years (range,14-72 years).All of them wereclassified into stage-3 arthritis according to Morrey-Wiedeman,among whom 31 had obvious foot varus deformity or equines deformity,and 16 were almost normal in appearance.The ankle joint function of patients were assessed by Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score,Maryland foot score systems and visual analog scale (VAS) preoperatively and at the last follow-up.Results The patients were followed up from 5 to 52 months (average,25 months).All the ankles got fused at the last follow-up,with one receiving removal of internal fixation and debride because of infection.Forty-three patients were satisfied with or without reservations; the others thought it so.The satisfaction rate was 91.5％(43/47).The Kofoed,AOFAS,Maryland foot scores and VAS were significantly improved from 48.11 ±5.00,53.38±5.52,49.74±5.71,7.89±0.87 to 80.96±6.07,82.21±4.26,88.94±5.14,2.28±1.10 respectively at the last follow-up.The normotopia X-ray of ankle joint showed that there were 22 cases in which the ankle got fused at neutral position,19 cases in which the eversion was less than 5°,3 cases in which the eversion was between 5° to 10°,2 cases in which the varus was less than 5°,and 1 case in which the varus was between 5° to 10°.Lateral X-ray showed that there were 32 cases in which the ankle got fused in dorsiflexion neutral position,12 cases plantar flexion 5°,and 3 cases plantar flexion 5° to 10°.Conclusion Ankle arthrodesis is still the preferable surgical treatnent option in patients with end-stage ankle arthritis,which shows high reliability and effectively in correcting deformity,pain relieving and function improvement.
