终末期关节病逆行单平面外翻髓内钉胫距跟融合

Tbiotalocalcaneal arthrodesis with single plane valgus retrograde intramedullary nail for the end-stage ankle arthropathy

摘要:

[目的] 探讨逆行单平面外翻髓内钉行胫距跟关节融合术治疗终末期踝关节病和后足畸形的临床疗效。[方法] 回顾性分析2017 年1 月—2022 年11 月本院采用逆行单平面外翻髓内钉行胫距跟关节融合术治疗终末关节病的26 例患者的临床资料，评价临床及影像结果。[结果] 患者均顺利完成手术，无神经、血管损伤等并发症。随访时间平均（38.5±21.9） 个月，与术前相比，术后3 个月及末次随访时，VAS 评分[(6.1±1.5), (3.7±0.7), (1.6±0.6), P＜0.001] 显著减少，AOFAS 评分[(45.3±4.9),(73.9±6.5), (77.8±5.9), P＜0.001] 显著增加。影像方面，患者内翻冠状位胫跟角（coronal tibiocalcaneal angle, CTCA） [(14.2±7.8) °,(4.4±1.1) °, (4.7±0.7) °, P=0.014]、外翻CTCA [(10.4±1.1) °, (3.9±0.5) °, (4.5±0.5) °, P=0.002] 均显著减小，矢状位胫跟角（sagittaltibiocalcaneal angle, STCA） 无显著变化（P＞0.05）。至末次随访时，25 例患者融合良好，融合时间平均（3.8±0.9） 个月，融合率为96.2%。[结论] 对于终末期踝关节病和后足畸形患者，采用逆行单平面外翻髓内钉行胫距跟关节融合术具有较好的临床疗效，术中神经、血管损伤风险更小。

Abstract:

[Objective] To investigate the clinical outcome of single plane valgus retrograde intramedullary nail used in tibiotalocalca-neal arthrodesis (TTCA) for end-stage ankle arthrosis with hind foot deformity. [Methods] A retrospective study was conducted on 26 pa-tients who underwent TTCA with single plane valgus retrograde intramedullary nail for terminal ankle arthrosis in our hospital from January2017 to November 2022. The clinical and imaging documents were evaluated. [Results] All the patients were operated on successfully with-out neurovascular injury and other complications, and followed up for an average of (38.5±21.9) months. With time preoperatively, 3 monthspostoperatively and at the latest follow-up, the VAS score was significantly decreased [(6.1±1.5), (3.7±0.7), (1.6±0.6), P＜0.001], while AO-FAS score [(45.3±4.9), (73.9±6.5), (77.8±5.9), P＜0.001] increased significantly. As for imaging, the varus coronal tibiocalcaneal angle (CT-CA) [(14.2±7.8)°, (4.4±1.1)°, (4.7±0.7)°, P=0.014], and the valgus CTCA [(10.4±1.1)°, (3.9±0.5)°, (4.5±0.5)°, P=0.002] significantly re-duced, while the sagittal tibiocalcaneal angle (STCA) had no significant changes (P＞0.05). Up to the last follow-up, 25 patients had good fu-sion, with an average fusion time of (3.8±0.9) months, and the fusion rate of 96.2%. [Conclusion] For end-stage ankle arthrosis with hindfoot deformity, single plane valgus retrograde intramedullary nail used in TTCA achieves satisfactory clinical consequence with less risk ofintraoperative neurovascular injury.