踝上截骨钢板固定和Ilizarov技术牵引矫形治疗内翻型踝关节炎的临床对比研究

发布时间：2018-05-05 12:23

本文选题：踝关节炎 + 踝上截骨　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:对比踝上截骨钢板内固定术与踝上截骨联合Ilizarov架牵伸治疗内翻型踝关节炎临床疗效。方法:收集2015年2月至2017年2月在我院骨病矫形外科手术治疗的41例内翻型踝关节炎患者的完整临床资料,采用回顾性研究方法,将不同治疗方式的患者分为A、B两组,其中A组采用踝上截骨解剖钢板内固定;B组采用踝上截骨法联合Ilizarov技术外固定。A组21例,术前AOFAS-HA评分46.71±9.30;B组20例,术前AOFAS-HA评分45.92±8.91。统计A、B组病例的手术时间、出血量、术前术后影像学改变、术后并发症发生率的差异。术后3个月、6个月、12个月时,采用AOFAS-HA评分对患者进行疗效评价,于术后6个月测量TAS、TLS值。结果:A组(钢板固定组)手术时间(75.50±24.36)min,术中出血量(100.30±30.36)ml;A组21例,随访时间3~24个月,平均(14.8±3.1)个月。B组(Ilizarov牵张固定组)手术时间(60.10±23.55)min,出血量(70.70±40.12)ml;B组2 0例,随访时间3~24个月,平均(13.6±1.5)个月。两组手术时间、术中出血量,术后并发症,比较差异有统计学意义,TAS、TLS值无统计学意义。术后A组6例出现并发症,B组3例出现,两组比较差异具有统计学意义。术后3个月AOFAS-HA评分无统计学意义。术后6月AOFAS-HA评分A组(70.15±1.32),B组(75.35±1.16),具有统计学意义。术后12个月时,A组AOFAS-HA评分为(83.45±1.59),B组为(83.15±1.95),两组比较差异无统计学意义(t=-7.21,P0.05)。结论:踝上截骨联合Ilizarov牵张外固定技术较踝上截骨钢板内固定术,有创伤小,出血少,术后并发症少,可以改善近期患者的踝关节功能,远期TAS、TLS、AOFAS-HA评分值并无明显差异。两种手术均能有效改善内翻型踝关节炎临床症状。
[Abstract]:Objective: to compare the clinical effect of supramalleolar osteotomy with plate fixation and supramalleolar osteotomy combined with Ilizarov frame in the treatment of varus ankle arthritis. Methods: the complete clinical data of 41 patients with varus ankle arthritis treated by orthopaedic surgery from February 2015 to February 2017 in our hospital were collected. In group A, 21 cases were treated with supramalleolar osteotomy combined with Ilizarov technique, 20 cases in group B were treated with supramalleolar osteotomy and external fixation with Ilizarov technique, 20 cases in group B were treated with supramalleolar osteotomy and internal fixation with anatomical plate, and the preoperative AOFAS-HA score was 45.92 卤8.91 in group B. The time of operation, the amount of blood loss, the imaging changes before and after operation, and the incidence of postoperative complications were analyzed. At 3 months, 6 months and 12 months after operation, AOFAS-HA score was used to evaluate the curative effect of the patients, and the TLS value was measured 6 months after operation. Results the operative time was 75.50 卤24.36 min in group A (plate fixation group), and the intraoperative bleeding volume was 100.30 卤30.36 ml / min in group A. The follow-up time was 3 ~ 24 months (mean 14.8 卤3.1) months. The operation time of group B was 60.10 卤23.55 min, and the volume of blood loss was 70.70 卤40.12 ml / ml group B (n = 20). The follow-up time was 3 ~ 24 months, with an average of 13.6 卤1.5 months. There was no significant difference in the time of operation, the amount of intraoperative bleeding and postoperative complications between the two groups. Postoperative complications occurred in 6 cases in group A and 3 cases in group B, and the difference was statistically significant between the two groups. There was no significant difference in AOFAS-HA score 3 months after operation. The AOFAS-HA score of group A was 70.15 卤1.32 卤75.35 卤1.16, which was statistically significant 6 months after operation. At 12 months after operation, the AOFAS-HA score of group A was 83.45 卤1.59m and that of group B was 83.15 卤1.95.There was no significant difference between the two groups (P 0.05). Conclusion: the technique of supramalleolar osteotomy combined with Ilizarov distraction external fixation has less trauma, less bleeding and less postoperative complications than that of internal fixation with supramalleolar osteotomy plate. It can improve the function of ankle joint in the near future, and there is no significant difference in the long-term TASS-TLSAOFAS-HA score. Both operations can effectively improve the clinical symptoms of varus ankle arthritis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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