胫骨开槽与环锯法踝关节融合后临近关节退变的比较

背景：由于踝关节的特殊解剖结构,踝关节融合的方法较多并各有优势。 目的：比较胫骨开槽法及环锯法行踝关节融合的临床疗效。 方法：于2002-02/2011-02对苏州大学附属第一人民医院骨科招募的35例行踝关节融合的患者,分别采用胫骨开槽(n=19)及环锯截骨法(n=16)治疗,并对其进行随访观察比较。 结果与结论：所有35例患者均获随访,随访时间为8~96个月。胫骨开槽方法比环锯法踝关节融合手术时间长(P < 0.05),术中出血量多(P < 0.05)。术后8个月胫骨开槽组患者美国足踝外科协会评分高于胫骨开槽组(P < 0.05),胫骨开槽组有10例,环锯法有8例随访满5年,2组患者术后均有>1/3的患者出现临近关节退变症状。提示相较于环锯截骨法,环锯法行踝关节融合具有创伤小,操作简单,融合率高,并发症少等优点,但踝关节融合后临近关节的退变也不可忽视。 关键词：关节融合;踝关节;环锯;并发症;关节退变 doi:10.3969/j.issn.1673-8225.2012.13.021

Effect of tibia slotting versus trephine for ankle fusion on the degeneration of the adjacent joint

BACKGROUND: Because of the special anatomy of the ankle joint, there are many methods in ankle fusion, and each has its own advantages. OBJECTIVE: To analyze and compare the effect of tibia slotting versus trephine for ankle fusion discuss the degeneration of adjacent joints. METHODS: A retrospective study was carried out in 35 patients with ankle from February 2002 to February 2011 in the First Affiliated People’s Hospital of Soochow University. We used trephine (n=16) and slotted (n=19) in the tibia to fuse the patients’ ankle joint, then the effect was analyzed and compared. RESULTS AND CONCLUSION: All the 35 patients were followed-up for 8-96 months. The duration of ankle arthrodesis by tibia slotting was longer than that by trephine (P < 0.05), and the intraoperative blood loose was more (P < 0.05). The average American College of Foot and Ankle Society score at the 8th month follow-up in the tibia slotting group was higher than that in the trephine group (P < 0.05). Eighteen of the 35 patients were followed-up for at least 5 years, 10 cases in the tibia slotting group and 8 cases in the trephine group. Over one third of the patients in both two groups occurred adjacent joint degeneration. Compared with slotting in the tibia, trephine for ankle arthrodesis was a simple operation with small wound, higher fusion rate and less complications. However, the degeneration of the near joint should not be ignored.