摘要
目的探讨微创经皮空心螺钉跟距关节融合术治疗足踝创伤性关节炎的效果。方法抽取洛阳正骨医院2013年10月至2018年10月74例(74踝)足踝创伤性关节炎患者进行非随机、同期对照试验,将微创经皮空心螺钉跟距关节融合术治疗的37例(37踝)作为观察组,另选择后外侧"L"形切口植骨融合术治疗的37例(37踝)作为对照组,比较两组患者的手术情况、术前及术后1 d的血清氧化应激水平和疼痛介质含量,观察两组术前和术后3、6、12个月的踝关节疼痛程度和踝关节功能变化,记录两组患者术后并发症情况。结果观察组的手术时间、术后住院时间及关节融合时间短于对照组(P<0.05),手术切口小于对照组(P<0.05),术中出血量少于对照组(P<0.05);术后1 d,两组患者的血清丙二醛(MDA)、β-内咖肽(β-EP)、前列腺素E2(PGE2)及降钙素基因相关肽(CGRP)水平升高,谷胱甘肽过氧化物酶(GSH-Px)降低,观察组变化幅度小于对照组(P<0.05);术后3、6、12个月,两组踝关节疼痛视觉模拟评分(VAS)呈逐渐降低趋势,均低于术前(P均<0.05),美国足踝外科协会(AOFAS)评分呈逐渐升高趋势(P均<0.05),观察组变化幅度大于对照组,组内不同时间点和组间同时间点比较差异均有统计学意义(P均<0.05);观察组的并发症总发生率低于对照组(5.41%比27.03%,P<0.05)。结论微创经皮空心螺钉跟距关节融合术治疗足踝创伤性关节炎的疗效较后外侧"L"形切口植骨融合术更佳,能明显缩短手术时间和住院时间,促进其踝关节快速融合,并有效减轻术后疼痛,提高踝关节功能,降低并发症发生率。
Objective To explore the efficacy of minimally invasive percutaneous hollow screw heel arthrodesis in the treatment of traumatic ankle arthritis.Methods A total of 74 patients(74 ankles)with traumatic ankle arthritis in Luoyang Orthopedic Hospital from October 2013 to October 2018 were selected for non-randomized current controlled trials,of them,37 cases(37 ankles)with minimally invasive percutaneous hollow screw heel arthrodesis were selected as observation group,and another 37 cases(37 ankles)with posterior-lateral L-shaped incision and bone graft fusion were used as control group.The surgery status and serum oxidative stress level and pain medium content before surgery and 1 d after surgery were compared between the two groups.The ankle pain degree and ankle function were observed in the two groups before surgery and 3,6 and 12 months after surgery.The postoperative complications were recorded in the two groups.Results The surgical time,postoperative hospital stay and average joint fusion time in observation group were significantly shorter than those in control group(P<0.05),and the surgical incision was significantly shorter than that in control group(P<0.05),and the intraoperative blood loss was significantly less than that in control group(P<0.05).One day after surgery,the levels of serum malondialdehyde(MDA),β-endorphin(β-EP),prostaglandin E2(PGE2)and calcitonin gene-related peptide(CGRP)in the two groups were significantly elevated while the glutathione peroxidase(GSH-Px)was significantly decreased,and the changes in observation group were significantly smaller than those in control group(P<0.05).Three,six and twelve months after surgery,the visual analogue scale(VAS)of ankle pain in the two groups showed a gradually decreasing trend,and was significantly lower than that before surgery(P all<0.05),and the American orthopedic foot and ankle society(AOFAS)score showed a gradually increasing trend,and was significantly higher than that in control group(P all<0.05),and the changes in observation group were greater than those in control group,and there were significant differences within the groups at different time points and between the groups at the same time points(P all<0.05).The total incidence rate of complications in observation group was significantly lower than that in control group(5.41%vs.27.03%,P<0.05).Conclusions Minimally invasive percutaneous hollow screw heel arthrodesis for traumatic ankle arthritis has better efficacy than posterior-lateral L-shaped incision and bone graft fusion,and it can significantly shorten the surgical time and hospital stay and promote the rapid fusion of ankle joint,and relieve postoperative pain effectively,improve ankle function,and reduce the occurrence of complications.
作者
霍纪宝
刘新江
范会军
Huo Jibao;Liu Xinjiang;Fan Huijun(Department of Foot and Ankle Surgery,Henan Luoyang Orthopedic Hospital,Henan Orthopedic Hospital,Zhengzhou 450000,China)
出处
《中国实用医刊》
2020年第6期56-61,共6页
Chinese Journal of Practical Medicine
关键词
足踝创伤性关节炎
微创经皮空心螺钉跟距关节融合术
后外侧"L"形切口植骨融合术
Traumatic ankle arthritis
Minimally invasive percutaneous hollow screw heel arthrodesis
Posterior-lateral L-shaped incision and bone graft fusion
