外侧入路关节镜辅助微创距下关节融合

doi:10.6040/j.issn.1671-7554.0.2020.0551

摘要/Abstract

摘要： 目的探讨外侧入路踝关节镜辅助微创距下关节融合术(ASA)的临床效果。方法对21例距下关节炎的患者行单肢外侧入路踝关节镜辅助微创距下关节融合(ASA)术。观察汇总患者术前及术后美国足踝外科协会评分(AOFAS)、视觉模拟评分(VAS)、融合率、优良率、并发症及融合时间。行X线及CT检查观察距下关节融合情况。结果 21例患者均成功随访。随访12~41个月,平均(22.7±4.2)个月。随访期间无感染、坏死、退行性关节炎、血管神经损伤、螺钉断裂等并发症发生,出现踝外侧撞击疼痛1例、螺钉尾帽刺激1例、胫后神经部分损伤1例。21例患者X线均提示骨性融合,平均融合(8.3±0.5)周。AOFAS评分由术前的(41.73±3.87)分提高至末次随访的(83.24±3.65)分,差异有统计学意义(P<0.01);末次随访评分较差1例、中1例、良1例、优18例,优良率为90.48%。VAS评分由术前的(6.5±1.2)分变为末次随访的(1.5±0.4)分,差异有统计学意义(P<0.01)。结论外侧入路踝关节镜辅助微创距下关节融合具有创伤小、术后恢复快、并发症少、融合率高、效果确切等优点,是治疗距下关节病变的有效方法。

关键词: 外侧入路, 距下关节融合, 关节镜, 微创

Abstract: Objective To evaluate the clinical efficacy of lateral arthroscopic subtalar arthrodesis(ASA). Methods Lateral ASA was performed in 21 patients with unilateral subtalar joint arthritis. The American Orthopaedic Foot & Ankle Society(AOFAS)score before and after operation, visual analogue scoring(VAS), union rate, excellent rate, union time as well as postoperative complications were evaluated. Results All operations were successful. During the follow-up of 12-41(average 22.7±4.2)months, no complication such as infection, necrosis, degenerative arthritis, neurovascular injury or hardware failure occurred; lateral impingement pain was observed in 1 case, screw cap irritation in 1 case, and partial posterior tibia nerve injury in 1 case. All 21 patients showed bone fusion on X-ray, with an average of(8.3±0.5)weeks of fusion. The AOFAS score rose from 41.73±3.87 before operation to 83.24±3.65 at final follow-up(P<0.01), and VAS score increased from 6.5±1.2 to 1.5±0.4(P<0.01). At the final follow-up, 1 patient had poor rating, 1 had medium rating, 1 had fair rating, 18 had good rating, and the fair and good ratings accounted for 90.48%. Conclusion Lateral ASA is a safe and effective treatment of subtalar joint diseases, with advantages of few trauma, fast recovery, few complications and high fusion rate.

Key words: Lateral approach, Subtalar arthrodesis, Arthroscope, Minimal invasive

中图分类号:

R687.3

吴刚, 王世隆, 段笑然, 汪洋, 张洪川. 外侧入路关节镜辅助微创距下关节融合[J]. 山东大学学报 (医学版), 2020, 58(8): 107-114.

WU Gang, WANG Shilong, DUAN Xiaoran, WANG Yang, ZHANG Hongchuan. Lateral approach arthroscopic subtalar arthrodesis[J]. Journal of Shandong University (Health Sciences), 2020, 58(8): 107-114.

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