Li Jun, Huang Zeyu, Fang Yue, Huang Fuguo, Liu Lei
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Nov 15;31(11):1311-1315. doi: 10.7507/1002-1892.201702010.
To evaluate the effectiveness of Ilizarov external fixation and ankle arthrodesis in the treatment of late traumatic ankle arthritis.
Between June 2013 and June 2015, 27 patients with late traumatic ankle arthritis were treated with Ilizarov external fixation technique. There were 16 males and 11 females with an age of 27-69 years (mean, 45.7 years). Sixteen cases were on the left side, 11 on the right side. All the patients suffered from traumatic ankle fractures or ligament damages caused by initial traumas. After 6 months of standard conservative treatment, the results was invalid and all patients had ankle joint pain and movement disorders. The disease duration was 3-39 years (mean, 11.5 years). According to Takakura ankle arthritis staging, there were 16 cases in stage 3 and 11 cases in stage 4. The tibial-talar angle before operation was (102.55±4.02) ° measured on conventional double-feet loading anteroposterior and lateral X-ray films. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot joint score was 45.72±6.45, and the visual analogue scale (VAS) score was 8.61±1.96.
All the patients were followed up 15-42 months (mean, 28.1 months). All ankles achieved bony fusion, the clinical healing time was 12.9 weeks on average (range, 11-18 weeks). No persistent bleeding in the incisions and needle tract occurred during the follow-up. There were 4 cases of mild needle infection, 2 cases of anterior dislocation of talus, and 3 cases with different degree of limited activity. No traumatic bone defect, bone disconnection, and false joint formation was observed. At 12 months after operation, the AOFAS ankle and foot joint score, VAS score, and tibial-talar angle were 80.53±9.14, 2.77±0.82, and (94.36±2.48)°, respectively, which were significantly improved when compared with preoperative ones ( =16.17, =0.00; =14.28, =0.00; =9.01, =0.00). The effectivenss was excellent in 9 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 81.5%.
Satisfactory effectiveness can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of traumatic ankle arthritis, showing certain application prospect, while long-term effectiveness should be comfirmed by large sample randomized controlled trials.
评估伊里扎洛夫外固定术及踝关节融合术治疗创伤性晚期踝关节关节炎的疗效。
2013年6月至2015年6月，采用伊里扎洛夫外固定技术治疗27例创伤性晚期踝关节关节炎患者。其中男性16例，女性11例，年龄27 - 69岁（平均45.7岁）。左侧16例，右侧11例。所有患者均因初次外伤导致创伤性踝关节骨折或韧带损伤。经过6个月的标准保守治疗无效，所有患者均存在踝关节疼痛及活动障碍。病程3 - 39年（平均11.5年）。根据高仓踝关节关节炎分期，3期16例，4期11例。术前在常规双足负重正侧位X线片上测量胫距角为(102.55±4.02)°。美国足踝外科协会（AOFAS）踝足关节评分为45.72±6.45，视觉模拟评分法（VAS）评分为8.61±1.96。
所有患者随访15 - 42个月（平均28.1个月）。所有踝关节均达到骨性融合，临床愈合时间平均为12.9周（范围11 - 18周）。随访期间切口及针道无持续出血。发生轻度针道感染4例，距骨前脱位2例，活动度不同程度受限3例。未观察到创伤性骨缺损、骨不连及假关节形成。术后12个月，AOFAS踝足关节评分、VAS评分及胫距角分别为80.53±9.14、2.77±0.82及(94.36±2.48)°，与术前相比差异有统计学意义（ =16.17， =0.00； =14.28， =0.00； =9.01， =0.00）。疗效优9例，良13例，可5例，优良率为81.5%。
伊里扎洛夫外固定术及踝关节融合术治疗创伤性踝关节关节炎可获得满意疗效，具有一定的应用前景，但长期疗效有待大样本随机对照试验证实。
