关节镜辅助下踝关节融合术的疗效评估

Wang Jun-liang, Liu Yu-jie, Li Zhong-li, Wang Zhi-gang, Wei Min

Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China.

Zhongguo Gu Shang. 2011 Sep;24(9):719-22.

OBJECTIVE

To evaluate the methods and results of arthroscopy-assisted ankle arthrodesis.

METHODS

From January 2001 to May 2009, 25 patients with end-stage ankle joint pathology were treated with arthroscopy-assisted ankle arthrodesis. There were 18 males and 7 females with an average age of 47.5 years (ranged, 32 to 70 years). The locations were left ankle in 10 cases and right ankle in 15 cases, including 13 cases of post-traumatic osteoarthritis, 10 cases of Kaschin-Beck disease and 2 cases of rheumatoid arthritis. At pre- and post-operation, the 10-point VAS score for ankle pain was obtained; the ankle functional was evaluated by the American Orthopaedic Foot & Ankle Society ankle and hindfoot score, which include pain, activity limitations, maximum walking distance, walking surfaces, gait abnormality, sagittal motion, hindfoot motion, ankle-hind-foot stability, and alignment.

RESULTS

All the patients were follow-up,with a mean period of 27.5 months (ranged, 20 to 35 months). All the patients were free of pain and the gait was improved. There were no complications, such as neurovascular injuries, infection or hardware failure. All the patients achieved fusion in a mean of 11.7 weeks (ranged, 8 to 15 weeks). Overall, the mean 10-point visual analog scale (VAS) score decreased from (8.60 +/- 0.96) preoperatively to (1.20 +/- 0.82) postoperatively (t=27.326, P=0.000). After operation, the items of pain, activity limitations, maximum walking distance, walking surfaces, gait abnormality, sagittal motion, hindfoot motion, ankle-hind-foot stability, and alignment improved. AOFAS score was significantly increased from (36.44 +/- 9.90) points preoperatively to (82.44 +/- 4.96) points postoperatively (t=-19.178, P=0.000).

CONCLUSION

Arthroscopy-assisted ankle arthrodesis offered minimal trauma, high fusion rates, rapid recovery and low morbidity. This study confirmed the efficacy of the arthroscopy-assisted ankle arthrodesis for ankle joint pathology.

目的

评估关节镜辅助下踝关节融合术的方法及效果。

方法

2001年1月至2009年5月，对25例终末期踝关节病变患者行关节镜辅助下踝关节融合术。其中男性18例，女性7例，平均年龄47.5岁（范围32至70岁）。病变部位：左侧踝关节10例，右侧踝关节15例，包括创伤后骨关节炎13例、大骨节病10例、类风湿关节炎2例。术前及术后采用10分制视觉模拟评分法（VAS）评估踝关节疼痛程度；采用美国足踝外科协会（AOFAS）踝关节与后足评分评估踝关节功能，该评分包括疼痛、活动受限、最大行走距离、行走路面、步态异常、矢状面活动、后足活动、踝关节与后足稳定性及对线情况。

结果

所有患者均获随访，平均随访时间27.5个月（范围20至35个月）。所有患者疼痛消失，步态改善。无神经血管损伤、感染或内固定失败等并发症发生。所有患者平均在11.7周（范围8至15周）实现融合。总体而言，10分制视觉模拟评分法（VAS）平均得分从术前的（8.60±0.96）分降至术后的（1.20±0.82）分（t=27.326，P=0.000）。术后，疼痛、活动受限、最大行走距离、行走路面、步态异常、矢状面活动、后足活动、踝关节与后足稳定性及对线情况等项目均得到改善。AOFAS评分从术前的（36.44±9.90）分显著提高至术后的（82.44±4.96）分（t=-19.178，P=0.000）。