锁定钢板与逆行髓内钉融合胫距跟关节治疗Charcot踝关节病的效果比较

目的 比较锁定钢板与逆行髓内钉融合胫距跟关节治疗Charcot踝关节病的临床效果。方法 回顾性研究。纳入2012年4月—2018年5月中国医科大学附属第一医院骨科25例Charcot踝关节病患者的临床资料。其中男10例,女15例;年龄41～72岁,平均58.5岁。患者均合并糖尿病。按手术方式不同分为两组,13例采用锁定钢板融合胫距跟关节(钢板组),12例采用逆行髓内钉融合胫距跟关节(髓内钉组),观察患者手术时间、术中出血量及切口愈合情况。术后定期随访,观察关节融合时间及切口感染,螺钉松动、移位、断裂,骨不连等并发症发生情况。术后1年采用美国足踝外科学协会(AOFAS)踝-后足功能评分评价患足功能,采用生活质量调查表(SF-36)评价患者的生活质量。结果 25例患者均顺利完成手术。钢板组手术时间为(86.23±6.98)min、术中出血量(77.18±9.82)mL、切口愈合时间为(3.4±1.0)周,髓内钉组手术时间(90.50±9.82)min、术中出血量(82.00±12.00)mL、切口愈合时间为(4.1±1.5)周,两组比较差异均无统计学意义(P值均＞0.05)。25例患者术后随访24～36个月,平均30个月。随访期间钢板组切口感染6例、螺钉脱落1例、骨不连1例,髓内钉组切口感染1例、骨不连3例,术后并发症发生率钢板组为8/13,髓内钉组为4/12,差异无统计学意义(P=0.238)。髓内钉组关节融合时间为(4.9±1.4)个月,长于钢板组的(3.5±0.9)个月,差异有统计学意义(t=3.007,P＜0.05)。术后1年,钢板组、髓内钉组AOFAS踝-后足评分分别为(81.8±8.5)分和(74.7±14.6)分,SF-36评分分别为(66.5±7.8)分和(63.0±9.4)分,两组间比较差异均无统计学意义(P值均＞0.05)。AOFAS评分评价患足功能:钢板组优2例、良6例、可3例、差1例,髓内钉组优1例、良5例、可1例、差5例;SF-36评分评价患者的生活质量:钢板组优3例、良10例,髓内钉组优1例、良11例。结论 锁定钢板和逆行髓内钉融合胫距跟关节治疗Charcot踝关节病均有良好的临床效果,但锁定钢板的融合效果要优于逆行髓内钉。

Comparison of locking plate and retrograde intramedullary nail for tibiotalocalcaneal arthrodesis in the treatment of Charcot ankle arthropathy

Objective To compare the clinical effect of locking plate and retrograde intramedullary nail for tibiotalocalcaneal arthrodesis in the treatment of Charcot ankle arthropathy.Methods The clinical data of 25 patients with diabetic Charcot ankle joint disease in the Department of Orthopedics of the First Affiliated Hospital of China Medical University from April 2012 to May 2018 were retrospectively analyzed. Among them, there were 10 males and 15 females. Their ages ranged from 41 to 72 years, with an average age of 58.5 years. All patients were complicated with diabetes. Among them, 13 patients were treated with tibial locking plate and screw fusion for arthropathy (plate group), while 12 patients were treated with retrograde intramedullary nails (intramedullary nail group). The operation time, intraoperative blood loss, and wound healing were observed. X-ray examination was performed to evaluate the joint fusion time and fusion rate during postoperative follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score and quality of life questionnaire (SF-36) were used to compare the postoperative recovery of the two groups. At the same time, the incision healing time, nail path, screw loss, and wound infection of both groups were observed.Results The operation was successfully performed in all 25 patients. In the plate group, the operation time was about (86.23±6.98) min, and the intraoperative blood loss was (77.18±9.82) mL. In the intramedullary nail group, the operation time was (90.50±9.82)min , and the intraoperative blood loss was (82.00±12.00) mL. No significant difference was observed in operation time and intraoperative blood loss between both groups (all P values＞0.05). All 25 patients were followed up for 24 to 36 months, with an average of 30 months. During the follow-up period, we observed 6 cases of wound infection, 1 case of screw detachment, and 1 case of bone nonunion in the plate group and 1 case of wound infection and 3 cases of bone nonunion in the intramedullary nail group. The incidence of postoperative complications was 8/13 in the plate group and 4/12 in the intramedullary nail group, with no statistically significant difference (P=0.238). The time of joint fusion in the intramedullary nail group was (4.9±1.4) months, which was longer than (3.5±0.9) months in the plate group, and the difference was statistically significant (t=3.007, P＜0.05). One year after surgery, the AOFAS and SF-36 scores of the plate and intramedullary nail groups were (81.8 ± 8.5) and (74.7±14.6), and (66.5±7.8) and (63.0±9.4), respectively. No significant difference was observed between the two groups (all P values＞0.05). The function of the affected foot was evaluated using the AOFAS score: 2 cases were rated as excellent, 6 cases as good, 3 cases as fair, and 1 case as poor in the plate group; meanwhile, 1 case was rated as excellent, 5 cases as good, 1 case as fair, and 5 cases as poor in the intramedullary nail group. The SF-36 score was used to evaluate the quality of life of patients: 3 cases were excellent, and 10 cases were good in the plate group; meanwhile, 1 case was excellent, and 11 cases were good in the intramedullary nail group.Conclusions The fusion of locking plate and retrograde intramedullary nail on the tibiotalocalcaneal joint has a good clinical effect in the treatment of Charcot joint disease of the ankle, and the fusion effect of locking plate is better than that of retrograde intramedullary nail.