保留或截断腓骨的踝上截骨术治疗内翻型踝关节骨关节炎疗效比较

发布时间：2018-06-29 11:08

本文选题：踝关节 + 骨关节炎　；参考：《中国修复重建外科杂志》2017年03期

【摘要】：目的比较踝上截骨术治疗内翻型踝关节骨关节炎时保留腓骨或截断腓骨对疗效的影响。方法回顾分析2009年4月—2014年4月,采用踝上截骨术治疗并随访达1年以上的41例(41足)内翻型踝关节骨关节炎患者临床资料。其中19例术中保留腓骨(A组),22例术中行腓骨截骨(B组)。两组患者性别、年龄、侧别、体质量指数、骨关节炎分期、病因以及术前美国矫形足踝协会(AOFAS)踝与后足评分、踝关节骨关节炎量表(AOS)疼痛及功能评分、踝关节活动度(range of motion,ROM)、胫骨远端关节面角(tibial articular surface angle,TAS)、距骨倾斜角(talar tilt angle,TT)、胫骨踝穴角(tibiocrural angle,TC)、胫骨侧位关节面角(tibial lateral surface angle,TLS)比较,差异均无统计学意义(P0.05),具有可比性。术后观察截骨愈合情况,比较两组末次随访时临床功能评分以及影像学测量结果。结果两组术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间16~55个月,平均36.6个月。A、B组各1例因疼痛及活动受限,行踝关节融合术,排除末次随访评价。X线片复查示,患者截骨处均获骨性愈合,A组愈合时间(3.6±0.4)个月,B组为(3.9±0.7)个月,比较差异无统计学意义(t=1.61,P=0.12)。末次随访时,两组TAS、TLS、TT、TC比较差异无统计学意义(P0.05),但B组TT、TC改善程度优于A组(P0.05)。两组AOFAS评分、AOS疼痛及功能评分、踝关节ROM比较,差异均无统计学意义(P0.05)。根据改良Takakura分期,A组改善率为55.6%,B组改善率为57.1%,组间比较差异无统计学意义(χ~2=0.01,P=0.92)。结论对于腓骨相对较长或影响术中胫距关节复位者,踝上截骨术中同时行腓骨截骨后TT及TC改善程度优于单纯踝上截骨术。
[Abstract]:Objective to compare the effect of preservation of fibula or amputation of fibula in the treatment of varus ankle osteoarthritis by supramalleolar osteotomy. Methods from April 2009 to April 2014, 41 patients (41 feet) with varus ankle osteoarthritis were treated with supramalleolar osteotomy and followed up for more than one year. Among them, 19 cases underwent fibula preservation (group A) and 22 cases underwent fibula osteotomy (group B). Sex, age, lateral sex, body mass index, osteoarthritis stage, etiology and preoperative AOFAS ankle and hind foot scores, ankle osteoarthritis scale (AOS) pain and functional scores were analyzed in both groups. There were no significant differences in motion of ankle, (tibial articular surface angle of distal tibia, (talar tilt angle of talus, tibiocrural angle of ankle and (tibial lateral surface angle of lateral articular surface of tibia (P0.05). After operation, the healing of osteotomy was observed, and the clinical function scores and imaging results were compared between the two groups at the last follow-up. Results the incisions of both groups were healed in the first stage, and there were no complications associated with the operation. All the patients were followed up for 16 ~ 55 months (mean 36. 6 months). One case in group A B underwent ankle arthrodesis because of pain and limited movement. The healing time of group A was (3.6 卤0.4) months and that of group B was (3.9 卤0.7) months. At the last follow-up, there was no significant difference in TTTC between the two groups (P0.05), but the improvement of TTTC in group B was better than that in group A (P0.05). There was no significant difference in AOFAS score AOS pain and function score and ankle ROM between the two groups (P0.05). According to the modified Takakura stage, the improvement rate of group A was 55.6% and the improvement rate of group B was 57.1%. There was no significant difference between the two groups (蠂 2 0. 01 P 0. 92). Conclusion for those whose fibula is relatively long or affects the reduction of tibiotalar joint, the improvement of TT and TC after sural osteotomy is better than that of supramalleolar osteotomy alone.
【作者单位】：西安交通大学医学院附属红会医院足踝外科;
【基金】：国家自然科学基金资助项目(81301604) 陕西省自然科学基础研究项目(2014JQ4164)~~
【分类号】：R687.31

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