骨赘清理结合Ilizarov关节牵伸术治疗中晚期踝关节炎

发布时间：2018-04-20 02:31

本文选题：骨赘清理术 + Ilizarov技术　；参考：《中国矫形外科杂志》2017年04期

【摘要】：[目的]探讨骨赘清理结合Ilizarov关节牵伸术治疗中晚期踝关节炎的临床疗效。[方法]回顾性分析2009年10月~2014年12月本科收治的9例中晚期踝关节炎的病例,女6例,男3例;年龄20~45岁,平均34.2岁。均为单侧发病。踝关节创伤病史5例,脊髓灰质炎后遗症足部矫形术后病史3例,无足部相关疾病史者1例。采用切开清除踝关节骨赘,然后安装术前已组装好的Ilizarov踝关节牵伸外固定器,术后逐渐牵伸并维持踝关节间隙5~8 mm负重行走。采用AOFAS踝-后足评分评价临床疗效。[结果]9例患者获得随访,末次随访时间为术后12~60个月,平均29.4个月。术后佩戴外固定器时间12~24周,平均16周。末次随访时AOFAS踝-后足评分76~89分,平均(81±7.2)分,较术前29~48分,平均(34.6±4.9)分,差异有统计学意义。未出现严重并发症。5例随访过程中出现轻中度外固定针道感染,给予局部酒精敷料包扎结合口服抗生素后控制。1例足跟固定针折断,未予特殊处理,拆除外固定装置时拔除。[结论]骨赘清理术结合Ilizarov关节牵伸术治疗中晚期踝关节炎是一种简单有效的方法,创伤小,能延缓关节置换或踝关节融合时间。
[Abstract]:Objective: to investigate the clinical effect of osteophyte debridement combined with Ilizarov joint drafting in the treatment of middle and late ankle arthritis. [methods] from October 2009 to December 2014, 9 cases of middle and late ankle arthritis were retrospectively analyzed, including 6 females and 3 males, aged 2045 years with an average of 34.2 years. All of them were unilateral. There were 5 cases of ankle trauma, 3 cases of poliomyelitis sequelae after orthopedic foot surgery, and 1 case of no history of foot related diseases. The osteophyte of ankle joint was removed by incision, and then the external fixator of Ilizarov was installed before operation. After the operation, the ankle joint space was gradually stretched and the ankle space was maintained with 58 mm weight-bearing walking. AOFAS ankle-hind foot score was used to evaluate the clinical efficacy. [results] Nine patients were followed up, the last follow-up time was 12 ~ 60 months (mean 29.4 months). The time of wearing external fixator was 12 ~ 24 weeks (mean 16 weeks). At the last follow-up, the AOFAS ankle-hind foot score was 7689, with an average score of 81 卤7.2, which was significantly higher than the preoperative score of 29 ~ 48 and the mean score of 34.6 卤4.9). There were no serious complications in 5 cases with mild and moderate infection of external fixation needle. After local alcohol dressing combined with oral antibiotics, 1 cases of heel fixation needle fracture were controlled, without special treatment, when the external fixator was removed, the external fixation device was removed. [conclusion] osteophyte debridement combined with Ilizarov arthrodesis is a simple and effective method for the treatment of middle and advanced ankle arthritis. It has less trauma and can delay the time of arthroplasty or ankle joint fusion.
【作者单位】：北京市垂杨柳医院矫形骨科;国家康复辅具中心附属康复医院矫形骨科;
【基金】：首都临床特色应用研究课题(编号:Z141107002514038)
【分类号】：R687.4

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