中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2015年
7期
699-706
,共8页
武勇%赖良鹏%王岩%王金辉%龚晓峰%许毅博%王满宜
武勇%賴良鵬%王巖%王金輝%龔曉峰%許毅博%王滿宜
무용%뢰량붕%왕암%왕금휘%공효봉%허의박%왕만의
踝关节%骨关节炎%关节成形术,置换,踝
踝關節%骨關節炎%關節成形術,置換,踝
과관절%골관절염%관절성형술,치환,과
Ankle joint%Osteoarthritis%Arthroplasty,replacement,ankle
目的 探讨全踝关节置换治疗终末期踝关节炎的临床疗效.方法 回顾性分析2005年1月至2013年5月采用全踝关节置换治疗并获得随访的73例终末期踝关节炎患者资料,男34例,女39例;年龄37~76岁,平均59.6岁;身高体重指数(body mass index,BMI)21.8~ 28.0 kg/m2,平均25.3 kg/m2;均为Morrey-Wiedeman关节炎分期3期.采用美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分、Kofoed踝关节评分及视觉模拟评分(visual analog scale,VAS)评价术前及末次随访时患者足踝关节功能.分别以年龄55岁和术前冠状面成角10°为界分组,比较两组间AOFAS评分及踝关节活动度(range of motion,ROM).结果 73例获得随访的患者中,除5例关节置换失败(2例衬垫断裂给予置换;2例金属假体移位或下沉,其中1例行胫距跟融合,1例翻修并融合下胫腓;1例深部感染一期取出假体二期融合)外,余68例随访时间为12~ 110个月,平均55.2个月.59例对疗效表示较满意,满意率为80.8% (59/73).AO-FAS踝与后足评分:术前(46.6±3.5)分,术后(86.6±4.3)分;Kofoed评分:术前(43.0±4.7)分,术后(82.6±4.6)分;VAS评分:术前(8.7±0.7)分,术后(3.0±1.0)分;ROM:术前34.4°±7.1°,术后45.1°±8.2°;各指标比较,术后较术前均明显改善.年龄55岁以下组的AOFAS评分、AOFAS功能项评分和ROM分别为(86.1±3.8)分、(47.0±2.7)分、45.7°±7.0°,55岁以上组分别为(86.7±4.6)分、(46.8±3.1)分、44.9°±8.8°;术前冠状面成角>10°(10° ~25°)组分别为(86.1±4.7)分、(47.0±2.7)分、43.0°±7.7°,术前冠状面成角< 10°(-5°~7°)组分别为(86.8±4.2)分、(46.8±3.1)分、46.1°±8.2°,两组各项比较均无差异.结论 人工全踝关节置换能有效缓解疼痛,提高踝关节活动度并改善功能,是治疗部分三期踝关节炎的良好选择;术前冠状面畸形不应成为全踝关节置换的禁忌证;全踝关节置换可扩大至部分年轻患者.
目的 探討全踝關節置換治療終末期踝關節炎的臨床療效.方法 迴顧性分析2005年1月至2013年5月採用全踝關節置換治療併穫得隨訪的73例終末期踝關節炎患者資料,男34例,女39例;年齡37~76歲,平均59.6歲;身高體重指數(body mass index,BMI)21.8~ 28.0 kg/m2,平均25.3 kg/m2;均為Morrey-Wiedeman關節炎分期3期.採用美國足與踝關節協會(American Orthopaedic Foot and Ankle Society,AOFAS)踝與後足評分、Kofoed踝關節評分及視覺模擬評分(visual analog scale,VAS)評價術前及末次隨訪時患者足踝關節功能.分彆以年齡55歲和術前冠狀麵成角10°為界分組,比較兩組間AOFAS評分及踝關節活動度(range of motion,ROM).結果 73例穫得隨訪的患者中,除5例關節置換失敗(2例襯墊斷裂給予置換;2例金屬假體移位或下沉,其中1例行脛距跟融閤,1例翻脩併融閤下脛腓;1例深部感染一期取齣假體二期融閤)外,餘68例隨訪時間為12~ 110箇月,平均55.2箇月.59例對療效錶示較滿意,滿意率為80.8% (59/73).AO-FAS踝與後足評分:術前(46.6±3.5)分,術後(86.6±4.3)分;Kofoed評分:術前(43.0±4.7)分,術後(82.6±4.6)分;VAS評分:術前(8.7±0.7)分,術後(3.0±1.0)分;ROM:術前34.4°±7.1°,術後45.1°±8.2°;各指標比較,術後較術前均明顯改善.年齡55歲以下組的AOFAS評分、AOFAS功能項評分和ROM分彆為(86.1±3.8)分、(47.0±2.7)分、45.7°±7.0°,55歲以上組分彆為(86.7±4.6)分、(46.8±3.1)分、44.9°±8.8°;術前冠狀麵成角>10°(10° ~25°)組分彆為(86.1±4.7)分、(47.0±2.7)分、43.0°±7.7°,術前冠狀麵成角< 10°(-5°~7°)組分彆為(86.8±4.2)分、(46.8±3.1)分、46.1°±8.2°,兩組各項比較均無差異.結論 人工全踝關節置換能有效緩解疼痛,提高踝關節活動度併改善功能,是治療部分三期踝關節炎的良好選擇;術前冠狀麵畸形不應成為全踝關節置換的禁忌證;全踝關節置換可擴大至部分年輕患者.
목적 탐토전과관절치환치료종말기과관절염적림상료효.방법 회고성분석2005년1월지2013년5월채용전과관절치환치료병획득수방적73례종말기과관절염환자자료,남34례,녀39례;년령37~76세,평균59.6세;신고체중지수(body mass index,BMI)21.8~ 28.0 kg/m2,평균25.3 kg/m2;균위Morrey-Wiedeman관절염분기3기.채용미국족여과관절협회(American Orthopaedic Foot and Ankle Society,AOFAS)과여후족평분、Kofoed과관절평분급시각모의평분(visual analog scale,VAS)평개술전급말차수방시환자족과관절공능.분별이년령55세화술전관상면성각10°위계분조,비교량조간AOFAS평분급과관절활동도(range of motion,ROM).결과 73례획득수방적환자중,제5례관절치환실패(2례츤점단렬급여치환;2례금속가체이위혹하침,기중1례행경거근융합,1례번수병융합하경비;1례심부감염일기취출가체이기융합)외,여68례수방시간위12~ 110개월,평균55.2개월.59례대료효표시교만의,만의솔위80.8% (59/73).AO-FAS과여후족평분:술전(46.6±3.5)분,술후(86.6±4.3)분;Kofoed평분:술전(43.0±4.7)분,술후(82.6±4.6)분;VAS평분:술전(8.7±0.7)분,술후(3.0±1.0)분;ROM:술전34.4°±7.1°,술후45.1°±8.2°;각지표비교,술후교술전균명현개선.년령55세이하조적AOFAS평분、AOFAS공능항평분화ROM분별위(86.1±3.8)분、(47.0±2.7)분、45.7°±7.0°,55세이상조분별위(86.7±4.6)분、(46.8±3.1)분、44.9°±8.8°;술전관상면성각>10°(10° ~25°)조분별위(86.1±4.7)분、(47.0±2.7)분、43.0°±7.7°,술전관상면성각< 10°(-5°~7°)조분별위(86.8±4.2)분、(46.8±3.1)분、46.1°±8.2°,량조각항비교균무차이.결론 인공전과관절치환능유효완해동통,제고과관절활동도병개선공능,시치료부분삼기과관절염적량호선택;술전관상면기형불응성위전과관절치환적금기증;전과관절치환가확대지부분년경환자.
Objective To explore the clinical results of total ankle replacements with the Scandinavian Total Ankle Replacement (STAR) prosthesis for end-stage ankle arthritis.Methods Data of 73 cases with end-stage ankle arthritis who received Scandinavian total ankle replacement from January 2005 to May 2013 were retrospectively analyzed.They were 34 males and 39 females,with an average age of 59.6 years old (range,37-76 years old),average body mass index (BMI) of 25.3 kg/m2 (range,21.8-28.0 kg/m2).All patients were classified into stage-3 arthritis according to Morrey-Wiedeman.Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) were used to evaluate the function of foot and ankle.Patients with a hindfoot deformity below 10° were compared with those who above 10°;and patients above 55 years old were compared with those who below it.Results 5 replacement failed (2 liner ruptured and received replacement;2 metal components displaced,1 received TTC fusion and the other underwent revision with inferior tibiofibular joint fusion,the last patient suffered from deep infection and received the STAR removal and secondary fusion) in 73,and the rest were followed up for 12 to 110 months (average,55.2 months).59 patients were satisfied with or without reservations.The satisfaction rate was 80.8% (59/73).The pre-op values of AOFAS,Kofoed,VAS and range of motion (ROM) were 46.6±3.5,43.0±4.7,8.7±0.7,34.4°±7.1° and the post-op values were 86.6±4.3,82.6±4.6,3.0±1.0,45.1°±8.2° respectively,and all were significantly improved compared with before.The AOFAS,AOFAS Function and ROM values of patients below 55 years old were 86.1±3.8,47.0±2.7,45.7°±7.0°,and the same values of patients above 55 were 86.7±4.6,46.8±3.1,44.9°±8.8°.The AOFAS,AOFAS Function and ROM values of patients with above 10° coronal deformity were 86.1±4.7,47.0±2.7,43.0°±7.7°,and the same values of patients below 10° were 86.8±4.2,46.8±3.1,46.1°±8.2°.There was no difference between the groups.Conclusion The STAR is the preferable surgical treatment option in patients with end-stage ankle arthritis,showing high reliability and effectivity in pain relieving and function improvement.