目的 比较腓骨瓣支撑联合空心螺钉固定行胫距跟关节融合术与腓骨截骨联合锁定钢板行胫距跟关节融合术的临床疗效。 方法 回顾性分析2016年6月~ 2019年6月我院行胫距跟关节融合术的患者87例，41例患者采用腓骨瓣支撑联合空心螺钉固定胫距跟关节融合术（腓骨瓣组），46例采用腓骨截骨联合锁定钢板行胫距跟关节融合术（锁定钢板组），比较两组手术时间、引流量、融合率、美国足踝外科协会（AOFAS）踝-后足评分、视觉模拟评分（VAS）及并发症情况。 结果 所有患者顺利完成手术，两组患者手术时间无统计学差异（P>0.05）；术后引流量腓骨瓣组（253.6±34.7）ml，锁定钢板组（212.8± 20.1）ml，差异有统计学意义（P<0.05）；术后10周融合率腓骨瓣组95.1%（39/41），明显高于锁定钢板组73.9%（34/46），差异有统计学意义（P<0.05）；术后6个月融合率，术后12个月AOFAS、VAS评分，差异均无统计学意义（P>0.05）。所有切口Ⅰ期愈合，锁定钢板组3例患者出现腓骨截骨端激惹表现。 结论 应用腓骨瓣支撑或锁定钢板均可实现胫距跟关节融合，腓骨瓣支撑联合空心螺钉固定保留了腓骨的部分血运，可以更快地实现融合，不易引起腓骨截骨端激惹症状，融合后踝关节的外形较优。
Abstract
Objective To compare the clinical efficacy of the trans-fibular approach locking plating versus fibular strut combined with hollow screw for tibial pitch and calcaneal arthrodesis. Methods A retrospective study was performed on the 87 patients who had undergone tibial pitch and calcaneal arthrodesis from June 2016 to June 2019 in our department. 41 were treated by fibular strut combined with hollow screw (fibular flap group) and 46 by locking plating (locking plate group). The operation time, drainage volume, fusion rate, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Scale, visual analogue scale(VAS) and complications were compared between the two groups. Results All patients received successful operation. There was no statistical difference in the operation time between the two groups (P>0.05). Postoperative drainage volume of fibular flap group was (253.6±34.7) mL and locking plate group (212.8±20.1) mL, there were statistical differences in the postoperative drainage volume between the two groups (P<0.05). The fusion rate at 10 weeks after operation of the locking plating group was (73.9 %) significantly lower than that of the fibular strut combined with hollow screw group (95.1 %) (P<0.05). There was no statistical difference in the fusion rate at 6 months after operation, AOFAS score, VAS score at 12 months after operation (P>0.05). All incisions were healed in the first stage and the fibula osteotomy site irritation appeared in 3 patients in the locking plate group. Conclusions Both open lateral ankle locking plating and fibular strut combined with hollow screw are effective procedure to tibial pitch and calcaneal arthrodesis. The fibular strut combined with hollow screw preserves part of the blood supply of the fibula and can achieve faster fusion. In addition, the irritation symptoms of the fibula osteotomy site is not obvious, and the shape of the ankle joint after fusionalso has advantages.
关键词
踝 /
终末期关节病； 开放外科踝关节融合术； 腓骨瓣支撑
Key words
Ankle; End-stage arthrosis /
Open lateral ankle arthrodesis; Fibular strut
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