镜下融合术治疗终末期创伤性踝关节炎

Arthroscopic ankle arthrodesis for treatment of end-stage traumatic ankle arthritis

摘要:

［目的］ 评价关节镜下无头加压空心螺钉踝关节融合术对终末期创伤性踝关节炎 （traumatic ankle arthritis, TAA） 的临床效果。［方法］回顾 2017 年 1 月—2020 年 5 月本院行踝关节融合术的患者，单侧终末期 TAA 采用镜下关节融合的患者 39 例，纳入本研究。总结患者临床与辅助检查资料。［结果］39 例患者均顺利完成手术，无严重并发症。随时间推移，39 例患者 VAS 评分显著减少（P<0.05），而 AOFAS 评分显著增加（P<0.05）。影像检查方面，术后 39 例患者踝关节正侧位对线良好，内固定物位置良好。影像显示骨性融合，术后 3 个月为 28/39 （71.79%），术后 12 个月为 39/39 （100%）。与术前相比，术后 3 d 患者的 TNF-α、IL-1β、IL-6、SOD 和 MDA 均显著增加，达峰值；而术后 7 d，上述指标均显著下降（P<0.05）。［结论］关节镜下无头加压螺钉踝关节融合术治疗晚期 TAA 患者的效果显著，术后炎性与应激反应指标下降。

Abstract:

[Objective] To evaluate the clinical outcomes of arthroscopic ankle arthrodesis with headless compression cannulated screws for end-stage traumatic ankle arthritis (TAA) . [Methods] A retrospective study was done on the patients who underwent ankle ar- throdesis in our hospital from January 2017 to May 2020. Of them, a total of 39 patients who received arthroscopic ankle arthrodesis for uni- lateral end-stage TAA were included in this study. The clinical and auxiliary examination data of the patients were summarized. [Results] All the 39 patients were successfully operated without serious complications. The VAS scores decreased significantly (P＜0.05) , whereas the AOFAS score significantly increased over time in 39 patients (P＜0.05) . In terms of radiographic examination, all 39 patients got good tibial foot alignment and proper implant position on anteroposterior and lateral X-ray films. Radiographs showed bony fusion was of 28/39 (71.79%) at 3 months and 39/39 (100%) at 12 months postoperatively. In term of blood tests, the levels of TNF-α, IL-1β, IL-6, SOD and MDA were significantly increased 3 days after operation, whereas decreased significantly 7 days after operation compared with those before operation (P＜0.05) . [Conclusion] Arthroscopic ankle arthrodesis with headless compression cannulated screws is considerably effective for the end-stage TAA, associated with remarkable subsidence of inflammatory and stress reaction postoperatively