摘要
目的 根据踝关节前方解剖相关结构研制出踝关节融合前路解剖钢板,并运用在踝关节融合术中评价其临床疗效.方法 利用人体骨骼模型解剖数据库,将数据导入Mimics 20.0软件中进行建模,通过踝关节前方解剖数据,利用3D打印辅助技术设计踝关节融合前路解剖钢板,分别应用于前路踝关节病灶清理/清除+植骨、融合手术治疗踝关节畸形、骨破坏、创伤性骨关节炎病变共9例,其中左侧7例,右侧2例;采用LSD-t检验对比分析术前、术后踝关节Kofoed评分、视觉模拟评分(VAS)评分以及美国矫形足踝协会(AOFAS)踝-后足评分.结果 所有接受踝关节融合前路解剖钢板患者术后切口均一期愈合,均在规定时间内随访,随访时间超过13个月,术后4～6个月影像学显示踝关节间隙骨性融合,疗效满意.AOFAS评分术前为(45.11±3.10)分,术后6周、3 个月、6 个月及末次评价分别为(77.78±3.15)、(78.89±2.71)、(81.00±2.55)、(82.89±2.09)分,随访时间段内均高于术前(F=300.56,P＜0.01);Kofoed评分术前平均为(49.78±3.96)分,术后6周、3个月、6个月及末次评价分别为(80.67±3.08)、(82.11±2.20)、(82.56±2.46)、(83.00±2.35)分,均高于术前(F=226.71,P＜0.01);疼痛 VAS 评分术前为(4.22±0.83)分,术后6周、3个月、6个月及末次评价分别为(3.33±0.71)、(2.44±0.53)、(1.67±0.50)、(1.56±0.53)分,随访时间段内均低于术前(F=36.12,P＜0.01).结论 踝关节融合前路解剖钢板为踝关节融合固定物临床效果佳.
Abstract
Objective The anterior anatomic plate of ankle joint fusion was developed according to the anatomic structure of ankle joint,and its clinical effect was evaluated in ankle joint fusion.Methods The anatomical database of human bone model was used to import the data into Mimics 20.0 software for modeling.Through the anatomic data of the anterior ankle joint,the anatomic plate of the anterior ankle joint fusion was designed using 3D printing assisted technology.It was used in the treatment of 9 cases of ankle deformity,bone destruction and traumatic osteoarthritis,including 7 cases on the left side and 2 ca-ses on the right side.The preoperative and postoperative Ankle Kofoed scores,visual analogue scores(VAS)scores and(ankle-Hindfoot Scale AOFAS)scores were compared by using LSD-t testwere com-pared.Results The incisions of all patients who received anterior anatomic plate for ankle fusion healed in one stage after surgery,and all patients were followed up within the specified time,with a follow-up time of more than 13 months.The imaging results showed bone fusion in the ankle space 4-6 months after sur-gery,and the curative effect was satisfactory.AOFAS score was(45.11±3.10)points before surgery[(77.78±3.15),(78.89±2.71),(81.00±2.55),(82.89±2.09)points]at 6 weeks,3 months,6 months and the last evaluation after surgery,respectively,which were higher during the follow-up period than before surgery,and the difference(F=300.56,P＜0.01);Kofoed score was(49.78±3.96)points before surgery[(80.67±3.08),(82.11±2.20),(82.56±2.46),(83.00±2.35)points]after 6 weeks,3 months,6 months and the last evaluation,respectively,which were higher than before surgery,and the difference(F=226.71,P＜0.01);The pain VAS score was(4.22±0.83)before surgery,and(3.33±0.71),(2.44±0.53),(1.67±0.50),(1.56±0.53)points at 6 weeks,3 months,6 months and the last evaluation were lower than before surgery(F=36.12,P＜0.01).Conclusion Anterior ana-tomic plate for ankle fusion has good clinical effect and is worthy of clinical promotion.
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