青少年踝内翻踝上截骨是否腓骨截骨的比较△

Supramolleolar osteotomy with or without fibular osteotomy for ankle varus deformity in adolescents

摘要:

［目的］比较踝上截骨矫正青少年踝内翻畸形是否腓骨截骨的临床疗效。［方法］回顾性分析 2010 年 1 月—2019 年 12 月踝上截骨矫正踝内翻畸形 29 例患者的临床资料。依据术前医患沟通结果，将患者分为两组，18 例保持腓骨完整 （fibula intact, FI），11 例同时行腓骨截骨 （fibular osteotomy, FO）。对比两组围手术期、随访及影像学资料。［结果］两组均顺利完成手术，无严重并发症。FI 组手术时间、切口总长度显著优于 FO 组（P<0.05）。两组术中出血量、术中透视次数、术后引流量、切口愈合等级和住院时间的差异均无统计学意义（P<0.05）。患者平均随访（49.72±19.44）个月。FI 组恢复下地行走时间和完全负重时间均显著早于 FO 组（P<0.05）。与术前相比，末次随访两组患者的 AOFAS 踝与后足评分显著增加（P<0.05），VAS 评分均显著降低（P<0.05），踝背伸-跖屈 ROM 差异无统计学意义（P>0.05）；相应时间点两组间上述指标的差异均无统计学意义（P>0.05）。 影像方面，至末次随访所有截骨均骨性愈合。与术前相比，术后两组胫骨远端关节面角、胫骨侧位关节面角、胫骨踝穴角均显著改善（P<0.05），距骨倾斜角无显著变化（P>0.05）。术后及末次随访时，FO 组 TC 角均显著优于 FI 组（P<0.05）。［结论］两组均可矫正胫骨远端内翻畸形。FI 组手术时间、切口长度、下地行走时间、完全负重时间优于 FO 组，而 FO 组对 TC 角矫正优于 FI 组。

关键词:骨骺损伤;踝内翻畸形;踝上截骨;腓骨截骨

Abstract:

[Objective] To compare the clinical outcomes of supramolleolar osteotomy with or without fibular osteotomy for correction of ankle varus deformity in adolescents. [Methods] A retrospective study was conducted on 29 adolescent patients (29 feet) who received supra- molleolar osteotomy for correction of ankle varus deformity in our department from January 2010 to December 2019. According to the preop- erative doctor-patient communication, the patients were divided into two groups, including 18 patients who maintained fibula intact (FI) , while 11 patients who underwent fibular osteotomy (FO) simultaneously. The perioperative period, follow- up and imaging data of the two groups were compared. [Results] All the patients in both groups had operation performed successfully without serious complications. The FI group proved significantly superior to the FO group in terms of operation time and total incision length (P＜0.05) , though there were no signifi- cant differences in intraoperative blood loss, intraoperative fluoroscopy times, postoperative drainage volume, incision healing grade and hos- pital stay between the two groups (P＞0.05) . All the patients in both groups were followed up for (49.72±19.44) months on a mean. The FI group resumed walking and full weight-bearing activity significantly earlier than the FO group (P＜0.05) . The AOFAS ankle and hindfoot scores significantly increased (P＜0.05) , while the VAS scores significantly decreased (P＜0.05) , and the ankle dorsal extension and plantar flexion range of motion (ROM) remained unchanged in both groups at the latest follow- up compared with those preoperatively (P＞0.05) , which proved not statistically significant at any matching time points between the two groups (P＞0.05) . Radiographically, all patients got os- teotomy healed at latest follow-up without a significant difference in healing time between the two groups (P＞0.05) . The tibial articular sur- face angle (TAS) , tibial lateral surface angle (TLS) and tibiocrural angle (TC) significantly improved (P＜0.05) , whereas the talar tilt angle (TT) remained unchanged postoperatively compared with those preoperatively in both groups (P＞0.05) . The FO group proved significantly superior to the FI group in term of TC immediately after operation and at the latest follow-up (P＜0.05) . [Conclusion] Supramolleolar osteot- omies with both FI and FO are effective correction of ankle varus deformity. The FI is superior to the FO in terms of operation time, incision length, times to resume walking and full weight-bearing activity, while the FO is superior to the FI in term of correction of TC.

Key words:epiphyseal injury; ankle varus deformity; supramolleolar osteotomy; fibular osteotomy