踝关节胫骨滑槽植骨融合术治疗大骨节病晚期的临床研究

目的 观察踝关节胫骨滑槽植骨融合术治疗大骨节病晚期临床疗效.方法 选择33例大骨节病晚期患者,行踝关节融合术,其中双踝手术5例,单纯右踝手术13例,左踝手术15例.术中采用胫骨滑槽植骨空心螺钉内固定,术后石膏外固定.随访0.5～6.0年,比较术前及末次随访美国矫形外科足踝协会（AOFAS）评分以判定疗效,X线片评估术后融合情况.结果 33例均未发生切口感染、血管神经损伤等严重并发症.末次随访时,30例无明显不适,3例踝关节轻度疼痛及轻度肿胀,长时间行走或站立后足跟部有轻度酸胀感,并未影响日常生活.AOFAS评分由术前的（25.84±16.81）分,提高至术后的（87.32±4.68）分,差异有统计学意义（P＜0.01）.临床疗效优25例,良5例,可2例,差1例.33例患者术后骨性融合率100％（33/33）.结论 采用踝关节胫骨滑槽植骨融合术治疗大骨节病晚期患者,操作简单、植骨融合率高、并发症少,疗效值得肯定.

Research of ankle chute tibia bone graft fusion in the treatment of late kaschin-beck disease

Objective To observe the clinical curative effect of ankle chute tibia bone graft fusion treatment of late kaschin-beck disease.Methods Thirty-three patients with late kaschin-beek disease performed ankle arthrodesis,the ankle surgery in 5 cases,simple right ankle surgery in 13 eases and 15 cases of left ankle surgery.Intraoperative used tibial chute hollow screw internal fixation and bone graft plaster external fixation postoperatively.Followed up 0.5-6.0 years,compared the American orthopaedic food and ankle society （AOFAS） score before surgery to determine the efficacy of last follow-up,X ray film fusion situation assessment in the postoperative period.Results Thirty-three cases did not occur postoperative incision infection,vascular or nerve complications.Last follow-up,30 cases were no obvious discomfort,3 cases of mild ankle pain,accompanied by walking or standing for a long time after the foot heel had mild acid bilges feeling,did not affect the daily life.The AOFAS score before surgery was significantly lower than that last follow-up [（25.84 ± 16.81） scores vs.（87.32 ± 4.68） scores] （P ＜ 0.01）.Clinical efficacy excellent in 25 cases,good in 5 cases,general in 2 cases,poor in 1 case.Follow-up X line piece was showed that in all cases to achieve bony fusion.Conclusion Using sliding kashin-beck terminal patients treated ankle bone graft fusion,simple operation,high bone graft fusion rate,less complications,curative effect is positive.