关节镜辅助踝关节融合术治疗晚期创伤性踝关节炎

 目的 探讨关节镜辅助踝关节融合术对保守治疗无效的晚期创伤性踝关节炎的治疗价值。方法 2007年7月至2010年12月，采用关节镜辅助踝关节融合术治疗晚期创伤性踝关节炎21例，男14例，女7例；年龄21～68岁，平均(37±13)岁。均为单侧手术。首次踝关节外伤至踝关节融合术的时间为1~41年，平均12.6年。患者术前均接受保守治疗无效，疼痛明显。术中彻底清除关节面软骨，行关节端“微骨折”处理，初步复位后以克氏针临时固定；“C”型臂X线机透视确认位置，拧入空心螺钉固定。2例同期行关节镜辅助距下关节融合术。术后石膏固定6~10周，部分负重锻炼直至骨性愈合。结果 全部患者获得随访，随访时间1～4年，平均1.8年。术后10~16周骨性愈合，平均12周。步态均得到改善，无切口愈合不良和感染等早期并发症。3例单纯踝关节融合患者术后出现距下关节炎伴疼痛，2例经保守治疗后症状缓解、1例行开放距下关节融合术后症状缓解。术前疼痛视觉模拟评分平均(8.1±1.5)分，术后1年平均(2.7±1.1)分，差异有统计学意义(t=3.153，P=0.005)。结论 对晚期创伤性踝关节炎，关节镜辅助踝关节融合术创伤小、切口小、融合率高，但对设备条件要求高，掌握该技术需要一定的学习曲线。

Arthroscopic ankle arthrodesis for end-stage post-traumatic ankle arthritis

Objective To investigate effect of arthroscopic ankle arthrodesis in the treatment of end-stage post-traumatic ankle arthritis. Methods Between July 2007 and December 2010, 21 patients with post-traumatic ankle arthritis underwent arthroscopic arthrodesis in our hospital. There were 14 males and 7 females, aged from 21 to 68 years (average, 37 years). Before operation, conservative treatments were unsuccessful in all patients. During operation, the articular cartilage was removed completely, and then micro-fracture was made in bone near articular surface. Then, the operating ankle were reduced and fixed provisionally with Kirschner wires. A C-arm X-ray system was used to confirm the reduction of operating ankle, and the operating ankle was fixed with cannulate screws if the reduction was satisfactory. Two patients also underwent arthroscopic subtalar arthrodesis. After operation, the affected ankle was fixed with plaster for six weeks. Then partial weight-bearing were allowed and gradually increased until bone union. Results All patients were followed up for 1 to 4 years (average, 1.8 years). All affected ankle achieved bone union after 10 to 16 weeks (average, 12 weeks). No early complications occurred, such as poor wound healing and infection. Subtalar arthritis with pain occurred in 3 patients; the symptom relieved in 2 of them after conservative treatment and in 1 patient after subtalar arthrodesis. The VAS score improved from preoperative 8.1±1.5 to 2.7±1.1 one year postoperatively, which showed statistical significance (t=3.153, P=0.005). Conclusion Arthroscopic ankle arthrodesis provides an alternative method for treating end-stage post-traumatic ankle arthritis, which has some advantages, such as less surgical trauma, more beautiful incision and higher fusion rate. However, it needs special equipments and a learning curve.