应用逆置交锁髓内钉行微创胫距跟关节融合术

目的 探讨逆置交锁髓内钉行胫距跟关节融合术治疗严重踝关节病变的疗效. 方法2003年1月至2007年11月应用逆置交锁髓内钉行胫距跟关节融合术治疗12例踝关节病变患者;男9例,女3例;年龄25～68岁,平均47.2岁.创伤后踝关节骨性关节炎7例,严重类风湿踝关节炎3例,马蹄足内翻2例.手术距原发病时间5～25年,平均13.6年.通过体格检查、问卷调查、踝负重下摄片和美国足踝协会(AOFAS)踝与后足功能评分标准进行临床和影像学评估. 结果所有患者获得18.3个月(10～36个月)随访.未出现血管神经损伤、骨不连和感染等并发症.患者均获得骨性融合,融合时间17周(12～21周).最后一次随访结果显示:无疼痛8例,轻度疼痛4例.7例运动和日常生活不受影响,5例运动受影响但不影响日常生活.7例在任何路面行走不受影响,5例在不平整的路面行走困难,无一例患者明显跛行.根据AOFAS踝与后足功能评分标准,术前平均47.3分(40～57分),术后平均74.2分(50～87分). 结论逆置交锁髓内钉行胫距跟关节融合术是治疗严重踝关节病变的一种微创、安全、有效的方法.

Minimally invasive tibiotalocalcaneal arthrodesis with a retrograde locking nail

Objective To discuss the therapeutic effect of tibiotalocalcaneal arthrodesis for severe painful ankle diseases using a locked retrograde intramednllary nail. Methods From January 2003 to November 2007, 12 patients with severe painful ankle diseases underwent tibiotalocalcaneal arthrodesis with a retrograde locking nail in our department. Their mean age was 47.2 (range, 25 to 68) years. The preoper-ative diagnoses of the 9 male and 3 female patients included posttraumatic osteoarthritis (n=7), rheumatoid arthritis (n=3) and eqninovarus (n=2). The mean interval between the primary disease and the operation was 13.6 (range, 5 to 25) years. All patients were evaluated clinically and radiographically by means of clinical examination, questionnaire, weight-bearing radiographic assessment and the American Foot and Ankle Society(AOFAS) ankle-hindfoot scale. Results All patients were available for the follow-up with an average duration of 18.3 (range, 10 to 36) months. Complications, such as damage to neurovascular struc-tures, non-union and infection, were not seen. Solid fusion was achieved in all ankles after a mean time of 17 (range, 12 to 21) weeks. At the latest follow-up, 8 patients reported no pain and 4 mild pain; 7 patients had no limitation in recreational or daily activities while 5 had limitation in recreational but not in daily activities; 7 patients experienced no difficult walking on any surface but 5 did on uneven terrain and stairs. No patient showed obvious limp. The preoperative mean AOFAS score was 47.3 (range, 40 to 57), and the postoperative one 74.2 (range, 50 to 87) . Conclusion Locked retrograde intramedullary nailing is a minimally in-vasive, effective and safe technique in tibiotalocalcaneal arthrodesis for severe painful ankle diseases.