关节镜下踝关节融合术螺钉位置和数量对融合时间的影响。

The effect of screw position and number on the time to union of arthroscopic ankle arthrodesis.

机构信息

Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.

出版信息

Arthroscopy. 2012 Dec;28(12):1882-8. doi: 10.1016/j.arthro.2012.06.019. Epub 2012 Oct 23.

DOI:10.1016/j.arthro.2012.06.019

PMID:23089350

Abstract

PURPOSE

This study aimed to investigate the factors that influence the time to union after arthroscopic ankle arthrodesis.

METHODS

From June 2005 to October 2010, 46 patients (50 ankles) underwent arthroscopic ankle arthrodesis with 6.0-mm cannulated cancellous screws. There were 22 men and 24 women (mean age, 63 years). Medical records and radiographs were retrospectively reviewed. Screw configurations used were as follows: 3 transmedial and translateral malleolar screws (ML3) in 12 ankles (24%), 2 transmedial and translateral malleolar screws (ML2) in 4 ankles (8%), 3 transmedial malleolar screws (M3) in 23 ankles (46%), and 2 transmedial malleolar screws (M2) in 11 ankles (22%).

RESULTS

Radiographic fusion was achieved in 46 (92%) of the 50 ankles. The mean time to fusion was 11.0 ± 4.5 weeks for ML3, 13.1 ± 3.3 weeks for ML2, 9.7 ± 2.7 weeks for M3, and 12.5 ± 3.5 weeks for M2 (P < .05). The mean American Orthopaedic Foot & Ankle Society scores were 81.3 ± 2.2 for ML3, 83.5 ± 4.4 for ML2, 88.3 ± 1.5 for M3, and 85.3 ± 2.2 for M2. The mean time until radiographic fusion was 10.2 ± 3.4 weeks for correction angles of less than 10° and 13.2 ± 3.4 weeks for angles of 10° or greater (P < .01). In obese patients a significant difference in ankle fusion time was observed (12.6 ± 3.5 weeks for patients with body mass index ≥25 v 9.4 ± 2.9 weeks for patients with body mass index <25, P < .01).

CONCLUSIONS

Overall, this study showed that arthroscopic ankle arthrodesis achieves a high rate of union, with fastest union achieved with 3 parallel screws placed medially from the distal tibia into the talus. Care should be taken when one is designing treatment strategies for obese patients and/or patients with large correction angles.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

摘要

目的

本研究旨在探讨关节镜下踝关节融合术后愈合时间的影响因素。

方法

2005 年 6 月至 2010 年 10 月，46 例（50 足）采用 6.0mm 空心松质骨螺钉行关节镜下踝关节融合术，其中男 22 例，女 24 例（平均年龄 63 岁）。回顾性分析病历和影像学资料。螺钉的固定方式如下：3 枚经内侧及外侧胫距骨螺钉（ML3）固定于 12 足（24%），2 枚经内侧及外侧胫距骨螺钉（ML2）固定于 4 足（8%），3 枚经内侧胫距骨螺钉（M3）固定于 23 足（46%），2 枚经内侧胫距骨螺钉（M2）固定于 11 足（22%）。

结果

50 足中，46 足（92%）X 线片显示融合。ML3、ML2、M3 和 M2 的融合时间分别为 11.0 ± 4.5 周、13.1 ± 3.3 周、9.7 ± 2.7 周和 12.5 ± 3.5 周（P <.05）。ML3、ML2、M3 和 M2 的美国矫形足踝协会评分分别为 81.3 ± 2.2、83.5 ± 4.4、88.3 ± 1.5 和 85.3 ± 2.2。矫正角度＜10°和≥10°的 X 线片融合时间分别为 10.2 ± 3.4 周和 13.2 ± 3.4 周（P <.01）。肥胖患者（体质量指数≥25）的踝关节融合时间明显长于非肥胖患者（体质量指数＜25）（12.6 ± 3.5 周比 9.4 ± 2.9 周，P <.01）。