终末期踝及距下关节病胫距跟融合两种固定比较
Comparison of two internal fixations in tibiotalocalcaneal arthrodesis for end-stage ankle and subtalar arthropathy
祁阳 1才礼扬 2普星宇 2吴雲彪 1寇贤帅 1骆文远 2杨锦涛 1写文栋 1陈少龙2
作者信息
- 1. 甘肃中医药大学第一临床医学院(甘肃省人民医院),甘肃兰州 730000
- 2. 甘肃省人民医院骨科干部病区,甘肃兰州 730000
- 折叠
摘要
[目的]比较全螺纹无头加压螺钉与髓内钉胫距跟融合术(tibiotalocalcaneal arthrodesis,TTCA)治疗终末期踝及距下关节病的临床疗效.[方法]回顾性分析2018年—2022年本院采用TTCA治疗的52例(52足)患者.根据医患沟通结果,28例采用全螺纹无头加压螺钉固定(螺钉组),24例采用髓内钉固定(髓内钉组).比较两组患者围手术期、随访及影像学资料.[结果]所有患者均顺利完成手术.两组患者在手术时间、切口总长度、术中失血量、术中透视次数、下地行走时间、切口愈合、皮神经损伤、住院时间方面差异均无统计学意义(P＞0.05).两组患者均获随访12个月以上,螺钉组完全负重时间显著早于髓内钉组[(125.7±38.9)dvs(149.2±23.6)d,P=0.013].与术前相比,两组患者末次随访时VAS评分均显著减少(P＜0.05),与术后3个月相比,末次随访时,两组AOFAS评分显著增加(P＜0.05).螺钉组AOFAS评分术后3个月和末次随访时均显著优于髓内钉组[(61.5±4.8)vs(57.3±7.0),P=0.015;(75.2±6.7)vs(70.7±8.5),P=0.036].影像方面,与术前相比,末次随访时两组胫跟角(tib-iocalcaneal angle,TCA)、跟骨偏移(calcaneal offset,CO)、侧位内侧足弓角(internal arch angle,IAA)均显著减小(P＜0.05),相应时间点,两组上述影像指标的差异无统计学意义(P＞0.05).螺钉组影像关节融合时间显著早于髓内钉组(P＜0.05).[结论]相较髓内钉,全螺纹无头加压螺钉行TTCA在AOFAS评分、完全负重时间及关节面融合情况方面取得了更好的效果,是一种治疗终末期踝及距下关节病的较好方法.
Abstract
[Objective]To compare the clinical outcomes of the fully threaded headless compression screws(FTCS)versus intramedul-lary nails(IMN)used as internal fixations in tibiotalocalcaneal arthrodesis(TTCA)for end-stage ankle and subtalar arthropathy.[Methods]A retrospective study was conducted on 52 patients(52 feet)who received TTCA for end-stage ankle and subtalar osteoarthritis in our hospi-tal from 2018 to 2022.Based on the preoperative patient-doctor discussion,28 patients had tibiotalocalcaneal joints fixed with multiple FTC-Ss,while the remaining 24 patients were fixed with IMN.The documents regarding to perioperative period,follow-up and images were com-pared between the two groups.[Results]All the patients in both cohorts had TTCA performed successfully,without statistically significant differences between the two groups in terms of operation time,total length of incision,intraoperative blood loss,number of intraoperative fluo-roscopy,ambulation time,incision healing grade,ratio of percutaneous nerve injury,and hospital stay(P＞0.05).The follow-up period lasted for more than 12 months,and the FTCS group resumed full weight-bearing activity significantly earlier than the IMN group[(125.7±38.9)days vs(149.2±23.6)days,P=0.013].The VAS scores significantly decreased at the last follow-up compared with that preoperatively(P＜0.05),while the AOFAS scores significantly increased at the last follow-up compared with that 3 months postoperatively in both groups(P＜0.05).The FTCS group proved significantly superior to the IMN group in term of AOFAS score 3 month postoperatively and at the latest fol-low-up[(61.5±4.8)vs(57.3±7.0),P=0.015;(75.2±6.7)vs(70.7±8.5),P=0.036].As for imaging,the tibiocalcaneal angle(TCA),calcaneal off-set(CO)and internal arch angle(IAA)significantly improved in both groups at the latest follow-up compared with those preoperatively(P＜0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P＞0.05).However,the FTCS group got bony fusion on images significantly earlier than the IMN group(P＜0.05).[Conclusion]The FTCS achieved considerably better outcome in terms of AOFAS scores,time to regain full weight bearing activity,and bony fusion time on images over the IMN for end-stage an-kle and subtalar arthropathy in this paper.
关键词
踝及距下关节病/胫距跟关节融合术/全螺纹无头加压螺钉/髓内钉Key words
ankle and subtalar arthropathy/tibiotalocalcaneal arthrodesis/all-thread headless compression screw/intramedullary nail引用本文复制引用
基金项目
甘肃省青年科技基金计划(21JR1RA009)
甘肃省人民医院院内科研基金项目(22GSSYD-47)
甘肃中医药大学研究生"创新之星"项目(2023CXZX-756)
甘肃省自然科学基金项目(21JR11RA187)
出版年
2024
NETL
NSTL
万方数据