经皮空心螺钉加压固定踝关节融合术

 目的 探讨经皮空心螺钉加压固定踝关节融合术的临床疗效。方法 2005年4月至 2010年10月,12例单侧严重踝关节炎患者(Kellgren-Lawrence III级)接受经皮空心螺钉加压固定踝关节融合术。男7例, 女5例; 年龄25~71岁, 平均 42.0岁。病程 1~21年,平均 7.3年。类风湿关节炎 2例,创伤性关节炎 8例,骨关节炎2例。取踝关节前正中入路,暴露踝关节腔, 完整去除胫距关节软骨面, 暴露软骨下骨。从后上向前下经皮穿针,以空心螺钉加压固定胫距关节。手术前后采用美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝-后足功能评分进行功能评定,摄踝关节正侧位及踝穴位 X线片观察踝关节骨性融合情况。 结果 12例患者均得到随访,随访时间 6耀55个月,平均 21.5个月。 AOFAS踝-后足功能评分由术前(42.8±8.6)分增加至术后 6个月(66.6±5.4)分,差异有统计学意义(t=-3.075,P=0.012); 末次随访(72.3±4.6)分,与术前比较差异有统计学意义(t=-8.595,P= 0.006)。 X线片证实全部病例均骨性融合,融合时间 9耀21周,平均 13.5周。无感染,无局部皮肤坏死,无螺钉松动、退钉及断钉。结论 经皮空心螺钉加压固定踝关节融合术创伤小,融合率高,融合时间短,近期疗效满意,并发症少。

Minimally invasive ankle arthrodesis with percutaneous cannulated screws

Objective To evaluate the clinical results of minimally invasive ankle arthrodesis with percutaneous cannulated screws. Methods Between April 2005 and October 2010, 12 patients with the ankle arthrodesis for unilateral severe arthritis (Kellgren-Lawrence class Ⅲ) were prospectively analyzed, including 2 cases of rheumatoid arthritis, 8 cases of post-traumatic arthritis, and 2 cases of osteoarthritis. There were 7 males and 5 females with an average age of 42.0 years (range, 25-7 1). The average disease duration was 7.3 years (range, 1-21). The anterior median incision of 3.0-5.0 cm was made to explore the ankle joint.The cartilage of tibial-talus joint was completely debrided. Two guide pins were inserted from posterosuperior to anteroinferior, and cannulated screws were implanted to fix ankle joint. All patients were physically examined with an extended protocol of questionnaires and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Scales. Ankle fusion in all patients was evaluated by clinical examination, and conventional radiography including anterior-posterior, lateral and mortise views of the ankle. Results All 12 patients were followed up postoperatively for an average of 21.5 months (range, 6-55), and were proved be bone union by clinical examination and radiology with a mean of 13.5 weeks (range, 9-21). The AOFAS rating scale improved from a mean of 42.8±8.6 points at pre-operation to a mean of 66.6±5.4 points at post-operation 6 months,showing significant difference (t=-3.075, P=O.012), and to a mean of 72.3±4.6 at the final follow-up, also showing significant difference with pre-operation (t=-8.595, P=-0.006). There was no infection,local skin necrosis, screw loosing, and so on. Conclusion The minimally invasive ankle arthrodesis with percutaneous cannulated scews is a recommend procedure, with mini-invasion, short surgery time, high fusion rate, good clinical outcomes, few complications.