摘要
目的探讨采用踝上截骨术治疗不同程度内翻型踝关节骨关节炎的临床疗效。方法回顾性分析了13例患者(13例踝),其中男8例、女5例,年龄32-67(56.5±10.7)岁;左侧2例,右侧11例。根据改良Takakura踝关节骨关节炎分期,2期3例,3A期7例,3B期3例。均采用踝上截骨、附加关节内清理,腓骨截骨、外侧韧带修补术。术后均随访至少18月以上,对临床和放射学结果进行评估,并进行统计分析。在踝关节X线片上测量并比较手术前后胫骨前侧关节面角(TAS)、距骨倾斜角(TT)及胫骨侧位关节面角(TLS)的变化。结果平均视觉模拟量表评分和美国矫形足踝学会评分均得到显着改善(均P<0.001)。与术前评估相比,TAS,TT和TLS角在手术后得到了显着改善(所有,P<0.001)。通过对比末次随访与术前美国足踝骨科协会(AOFAS)踝与后足评分及踝关节骨关节炎量表(AOS)疼痛、功能评分进行临床疗效评估,13例患者随访18-65个月,平均34.9个月。1例因术后疼痛和功能障碍行踝关节融合。术前相比,术后AOFAS评分明显提高(54.6±14.2)分和(83.7±9.8)分,AOS疼痛评分(43.6±6.4)分和(26.6±5.2)分与功能评分(52.7±11.3)分和(35.4±10.3)分较术前明显下降,差异均有统计学意义(P值均<0.01),术前9例TT≥10°的患者中,有7例术后关节面协调性得到恢复。结论根据不同程度内翻型踝关节骨关节炎的解剖学特征,选择合适的踝上截骨方式治疗,并辅助相应的术式来充分矫正力线和稳定关节,其临床疗效肯定。
Objective To investigate the clinical efficacy of supramalleolar osteotomy in the treatment of varus ankle osteoarthritis.Methods 13 patients(13 ankles)were analyzed retrospectively,including 8 males and 5 females,aged from 32 to 67(56.5±10.7)years old,2 patients having osteroarthritis on the left side and 11 patients on the right side.According to the modified Takakura ankle osteoarthritis stage,there were 3 cases in stage 2,7 cases in stage 3A and 3 cases in stage 3B.All patients underwent supramalleolar osteotomy,additional intra-articular debridement,fibular osteotomy and lateral ligament repair.All patients were followed up for at least 1 year,and the clinical and radiological results were evaluated and statistically analyzed.The changes of anterior tibial facet angle(TAS),talar inclination angle(TT)and lateral tibial facet angle(TLS)were measured and compared on ankle X-ray films before and after operation.Results The average score of visual analogue scale and score of American Orthopaedic Foot Ankle association were significantly improved(P<0.001).Compared with preoperative evaluation,TAS,TT and TLS angles were significantly improved after surgery(P<0.001).The clinical efficacy was evaluated by comparing the ankle and hindfoot scores of the American Orthopaedic Association of foot and ankle(AOFAS)and the pain and function scores of ankle osteoarthritis scale(AOS)before the operation.13patients were followed up for 14-65 months,with an average of 34.9 months.One patient underwent ankle fusion due to postoperative pain and dysfunction.The AOFAS scores were significantly improved(54.6±14.2)and(83.7±9.8)points.AOS pain scores(43.6±6.4),AOS pain scores(26.6±5.2)and functional scores(52.7±11.3)and(35.4±10.3)scores were significantly lower than those before operation(P<0.01).Conclusion According to the anatomic characteristics of varus ankle osteoarthritis,it is effective to select appropriate supramalleolar osteotomy and assist the corresponding operation to fully correct the force line and stabilize the joint.
作者
王雪
赵博
阿衣丁·夏哈太
陀亚楠
王成伟
WANG Xue;ZHAO Bo;Ayiding Xiahatai;TUO yanan;WANG Chengwei(Department of orthopedics,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi,830002,China;Department of orthopedics,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi,830011,China)
出处
《新疆医学》
2022年第12期1382-1386,共5页
Xinjiang Medical Journal
基金
国家自然科学基金(项目编号:81860164)
关键词
骨关节炎
踝关节
截骨术
Osteoarthritis
ankle joint
osteotomy
