摘要
目的观察踝上截骨术治疗踝关节2期创伤性关节炎的疗效。方法自2005年10月至2008年5月对47例踝关节2期创伤性关节炎行踝上截骨术治疗，31例获得完整随访。12例行开放性楔形截骨术，其中10例胫骨内侧开放性楔形截骨术即时矫正踝关节内翻，此间有3例在即时矫正内翻的同时行跗管松解术，2例因踝关节严重内翻畸形愈合，截骨同时在Ⅱizarov治疗器下缓慢牵张矫正原始畸形愈合；19例行腓骨退旋延长术。采用美国骨科足踝外科协会（AOFAS）踝关节功能评分系统进行评分。结果3例获得12～43个月（平均27．3个月）随访。骨折全部愈合，临床愈合时间平均为13．3周（11～17周），完全负重时间平均为14．1周（12～19周）。术后12个月踝关节AOFAS评分为63-92分，平均84．3分，其中优14例，良11例，一般6例，优良率80．6％。术后2例出现内侧切口裂开，1例发生内侧切口皮缘部分坏死，均经换药保守治疗痊愈。31例术后出现足外侧皮肤感觉麻木，2例患者彳乇最近随访时X线片示关节炎有轻微进展，予以关节腔注射施沛特保守治疗后而无需手术即获得了满意的临床效果。无螺钉松动、断裂及内固定失效等其他并发症。结论采用踝七截骨术治疗踝关节2期创伤性关节炎，近期可获得满意效果。
Objective To investigate the therapeutic effects of supramalleolar osteotomy for secondary traumatie arthritis of the ankle joint. Methods Forty-seven patients with secondary traumatic arthritis of the ankle joint were admitted to our hospital from October 2005 to May 2008. Only 31 patients of them who had been availabletocompletefollow-upwereincludedinthisstudy. Oftbem, 12underwentopenwedge-shapedosteotomyand the other 19 the lengthening osteotomy of the fibula. In open wedge-shaped osteotomy, 10 eases had correction of the yarns deformity of the ankle instantly during the operation, 3 of whom also received the releasing of tarsal tunnel at the same time, while the other 2 ankles were treated with the llizarov external fixator to correct the malformation gradually due to severe varus deformity. The functions of the ankle were assessed by the American Orthopaedic Foot ＆ Ankle Society （AOFAS） scoring system. Results Ameanfollow-upof27.3 （12to43） months showed that all the fractures were healed in a mean time of 13.3 （ 11 to 17） weeks. The mean time for total weight-bearing was 14. 1 （ 12 to 19） weeks. The mean AOFAS score of the ankle function 12 months after the operation was 84.3. There were 14 excellent cases, 11 good and 6 fair ones （good to excellent rate： 80.6% ）. After the operation, 2 patients had wound disruption and 1 patient skin necrosis around the wound. Anaesthesia on the lateral side of the foot happened in 3 patients, and a slightly aggravated degeneration of the ankle joint in 2 patients. All complications responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion Supramalleolar osteotomy can lead to a good outcome in the early postoperative period for the secondary traumatic arthritis of the ankle joint.
出处
《中华创伤骨科杂志》
CAS
CSCD
2009年第12期1110-1113,共4页
Chinese Journal of Orthopaedic Trauma
关键词
踝关节
关节炎
截骨术
治疗结果
Ankle joint
Arthritis
Osteotomy
Treatment outcome
