关节镜监视下踝关节植骨融合术的疗效分析

目的：探讨关节镜辅助下踝关节清理、植骨融合术的手术方法和临床疗效。方法：2001年1月至2009年5月,采用关节镜辅助踝关节植骨融合术治疗踝关节病变25例,男18例,女7例;年龄32～70岁,平均47.5岁;左踝10例,右踝15例;其中创伤后骨关节炎13例,地方性大骨节病10例,类风湿性关节炎2例。手术前后采用疼痛视觉模拟评分（VAS）对踝关节疼痛进行评定,根据美国足踝关节协会评分系统（AOFAS）从疼痛、自主活动、最大步行距离、地面步行、步态、活动度、稳定性及踝关节对线等方面进行评价。结果：25例均获随访,时间20～35个月,平均27.5个月。术后踝关节无疼痛,步态明显改善,无神经血管损伤、感染和固定失败等并发症,平均骨性融合时间为11.7周（8～15周）。术后VAS评分为（1.20±0.82）分,较术前的（8.60±0.96）分明显降低（t=27.326,P=0.000）;术后AOFAS评分中客观项目均较术前改善,术后AOFAS评分为（82.44±4.96）分,较术前的（36.44±9.90）分明显增加（t=-19.178,P=0.000）。结论：关节镜监视下踝关节植骨融合术操作简单,术中创伤小,术后恢复快、并发症少,是踝关节融合的理想方法。

Outcome evaluation of arthroscopy-assisted ankle arthrodesis

Objective: To evaluate the methods and results of arthroscopy-assisted ankle arthrodesis. Methods: From January 2001 to May 2009,25 patients with end-stage ankle joint pathology were treated with arthroscopy-assisted ankle arthrodesis. There were 18 males and 7 females with an average age of 47.5 years(ranged,32 to 70 years). The locations were left ankle in 10 cases and right ankle in 15 cases,including 13 cases of post-traumatic osteoarthritis,10 cases of Kaschin-Beck disease and 2 cases of rheumatoid arthritis. At pre- and post-operation,the 10-point VAS score for ankle pain was obtained;the ankle functional was evaluated by the American Orthopaedic Foot & Ankle Society ankle and hindfoot score,which include pain,activity limitations,maximum walking distance,walking surfaces,gait abnormality,sagittal motion,hindfoot motion,ankle-hindfoot stability,and alignment. Results: All the patients were follow-up,with a mean period of 27.5 months(ranged,20 to 35 months). All the patients were free of pain and the gait was improved. There were no complications,such as neurovascular injuries,infection or hardware failure. All the patients achieved fusion in a mean of 11.7 weeks(ranged,8 to 15 weeks). Overall,the mean 10-point visual analog scale (VAS) score decreased from (8.60±0.96) preoperatively to (1.20±0.82) postoperatively(t=27.326,P=0.000). After operation,the items of pain,activity limitations,maximum walking distance,walking surfaces,gait abnormality,sagittal motion,hindfoot motion,ankle-hindfoot stability,and alignment improved. AOFAS score was significantly increased from (36.44±9.90) points preoperatively to (82.44±4.96) points postoperatively(t=-19.178,P=0.000). Conclusion: Arthroscopy-assisted ankle arthrodesis offered minimal trauma,high fusion rates,rapid recovery and low morbidity. This study confirmed the efficacy of the arthroscopy-assisted ankle arthrodesis for ankle joint pathology.