逆行交锁髓内钉治疗胫距及距下关节创伤性关节炎

[目的]评价逆行交锁髓内钉用于胫距、距下关节创伤性关节炎关节融合的效果。[方法]应用关节间隙植骨融合加钛合金逆行交锁髓内钉固定术治疗创伤性胫距及距下关节退变18例，其中男8例，女10例。年龄42—69岁，平均57．5岁。9例伴踩外翻，2例伴马蹄内翻。手术距原发创伤的时间5-13年，平均7．6年。手术取部分远端腓骨植入关节间隙，自跟骨向胫骨逆行置钉并常规作近、远端锁钉。术前、术后对患者行AOFAS评分，并通过影像评价植骨融合效果。[结果]所有患者均获随访，随访时间6—22个月，平均13．5个月。术后切口愈合均正常，恢复负重的时间9—16周，平均13．6周。手术后1名患者出现腔隙性脑梗塞。1人（5％）于平地行走时中度疼痛；2人（11％）于崎岖路面上行走时出现轻-中度疼痛；1人（5％）站立时轻度疼痛。14人（79％）无疼痛。手术前后患者的AOFAS平均评分分别为43．5分（40-52分）和69分（56—84分）。13人（72％）植骨完全融合，时间12～48周，平均16．8周；3人（17％）不完全融合；2人（11％）未融合。[结论]植骨融合加逆行交锁髓内钉固定是治疗胫距、距下关节创伤性关节炎的有效方法。

Retrograde intramedullary nail for traumatic tibiotalocalcaneal arthritis

[Objective]To evaluate the outcome of tibiotalocalcaneal fusion in traumatic arthritis patients using the locked retrograde intramedullary nail with graft.[Method]Eighteen ankles underwent this procedure.There were 8 males and 10 females,9 with valgus and 2 with talipes equinovarus,all unilateral.The mean age of patients was 57.5 years(ranged,42~69) and the mean time between the procedure from primary trauma was 7.6 years(5~13 years).Bone graft were picked from distal fibula.The nail was inserted through a plantar approach with locking screws placed both proximally and distally.Patients were evaluated by a standardized follow-up examination using the AOFAS and the fusion outcome were observed radiographically.[Result]All patients were available for an average duration of follow-up of 13.5 months(ranged,6~22 months).All wound healed normally.The mean time of full bearing from operation was 13.6 weeks(ranged,9-16 weeks).One patient was found cerebral thrombosis after operation.One patient had moderate pain while walking on even surface,2 mild to moderate pain on uneven surface,1mild pain while standing and 14 relieved from pain.The average AOFAS score improved from 43.5(ranged,40~52) to 69(ranged,56~84) points.Solid fusion was achieved in 13 ankles(72%) after a mean follow-up of 16.8 months(ranged,12~24 months).Partial union was observed in 3 patients(17%) and non-union in 2 patients(11%).[Conclusion]Locked retrograde intramedullary nail fusion with bone graft is effective for traumatic tibiotalocalcaneal arthritis.