关节镜下经皮穿针空心螺钉内固定融合治疗距下关节创伤性关节炎

目的 探讨关节镜下经皮穿针空心螺钉内固定融合治疗距下关节创伤性关节炎的方法并评价其临床疗效.方法 选择2006年4月-2009年12月收治的12例严重距下关节创伤性关节炎患者,其中男5例,女7例;年龄28～68岁,平均45.6岁.均为单纯距下关节病变,经保守治疗、疼痛控制无效,选择关节镜下经皮穿针空心螺钉内固定的距下关节融合术.患者术前、术后均采用美国足踝外科协会(America Orthopedic Foot and Ankle Society,AOFAS)踝-后足功能评分表进行临床随访,同时,采用X线摄片进行影像学评估.结果 术后平均随访21.2个月(6～48个月).12例患者AOFAS术前评分(54.67±5.28)分(43～61分),术后末次随访评分(89.17±3.56)分(78～95分),优良率为93%.术后X线片显示,11例距下关节骨性融合,平均融合时间为12.4周(9～15周).1例出现骨不连,行走后外踝下方疼痛,给予石膏靴固定制动3个月后复查X线片,距下关节骨性融合.结论 关节镜下经皮穿针空心螺钉内固定融合治疗距下关节创伤性关节炎可获得良好的临床疗效,是一种值得推荐的手术方法.

Percutaneous cannulated screw fixation with subtalar fusion for treatment of post-traumatic subtalar arthritis under arthroscope

Objective To investigate the clinical outcome of arthroscopic percutaneous cannulated screw fixation with subtalar fusion in the treatment of post-traumatic subtalar arthritis. Methods The study involved 12 patients (five males and seven females) with severe post-traumatic subtalar arthritis admitted to our hospital from April 2006 to December 2009. The patients were at age range of 28-68 years ( mean 45.6 years). All patients had the history of conservative treatment but failed in pain alleviation.Then, the percutaneous cannulated screw fixation plus subtalar fusion was selected. The ande and hind foot of all patients were evaluated preoperatively and postoperatively by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Imaging assessment was carried out by X-ray examination.Results The patients were followed up for mean 21.2 months (range 6-48 months), which showed thatthe mean AOFAS ankle-hindfoot scale was increased from (54.67 ± 5.28 ) points (range 43-61 points)preoperatively to (89.17 ±3.56) points (range 78-95 points) at final follow-up, with excellence rate of 93%. Eleven patients got good fusion with the mean time of 12.4 weeks (range 9-15 weeks). Only one patient had nonunion, with the pain in the lateral malleolus. The subtalar joint of the patient got union after plaster immobilization for three months, which was proved by X-ray examination. Conclusions The arthroscopic percutaneous cannulated screw fixation and subtalar fusion can acquire good clinical outcomes and hence is a recommended procedure for post-traumatic subtalar arthritis.