无头加压螺钉联合PHILOS钢板固定在胫距跟关节融合中的应用

目的探讨应用无头加压螺钉联合PHILOS钢板行胫距跟关节融合术治疗胫距、距下关节严重病变的临床疗效。方法笔者自2011-02—2014-02采用经外踝截骨入路、无头加压螺钉联合PHILOS钢板行胫距跟关节融合术治疗13例胫距、距下关节病变患者。所有患者均有足踝部疼痛,功能受限。术后功能评价采用美国骨科足踝协会(AOFAS)踝和后足评分系统。结果 1例失访,12例获得随访12~24个月,平均16.7个月。切口均一期愈合,术后平均11.3(8~16)周达骨性愈合。末次随访患者关节疼痛完全缓解,无内固定失败及融合失败等并发症发生,末次随访所有患者踝关节疼痛均得到明显缓解,无行走痛,步态基本正常。术前AOFAS评分为(48.75±6.8)分,末次随访AOFAS评分为(83.5±8.4)分,术后AOFAS评分优于术前,差异有统计学意义(t=18.790,P0.001)。2例出现足背外侧皮肤感觉减退,末次随访未恢复。结论经外踝截骨无头加压螺钉联合PHILOS钢板行胫距跟关节融合术,固定强度可靠,融合率高,是临床治疗踝关节和距下关节严重关节疾病的一种有效方法。

Tibiatalocalcaneal arthrodesis and fixation with headless compression screw and antiskid plate

Objective To investigate the clinical outcome of tibiotalocalcaneal arthrodesis using lateral malleolus osteotomy and fixation with headless compression screw and antiskid plate (proximal humeral internal locking system,PHILOS) in treatment of severe tibiotalar and talocalcaneal bone disease.Methods The lateral malleolus osteotomy,headless compression screw with PHILOS plate tibial fistula were used for 13 cases of joint fusion for tibia and subtalar joint disease from February 2011 to February 2014.All patients had ankle pain and limited function.Postoperative functional evaluation was performed using the American Orthopedic Ankle Joint Association (AOFAS) ankle and hindfoot score system.Results One patient lost control,12 patients were followed up for 12 to 24 months,an average of 16.7 months.The incision healed in one stage,and the average bone healing time was 11.3(8-16) weeks.No complications such as failure of internal fixation and failure of fusion were found in the patients at the last follow-up.The pain of ankle joint was relieved in all patients at the last follow-up,and the gait was normal.The AOFAS score was (83.5±8.4) at the last follow-up.The AOFAS score was (48.75±6.8) preoperatively.The AOFAS score arffer operation was significantly higher than that before the operation (t =18.790,P ＜0.001).Two patients had dorsal lateral dorsal skin sensation,without recovery at the last follow-up.Conclusion Tibiatalocalcaneal arthrodesis using lateral malleolus osteomy and fixation with headless compression screw and antiskid plate (PHILOS) is proved to be effective in treatment of severe tibiotalar and talocalcaneal bone disease.It can provide rigid fixation and result in high fusion rate.