胫距跟融合治疗终末期踝和后足病变的中短期临床结果

doi:10.19723/j.issn.1671-167X.2024.02.015

摘要/Abstract

摘要：

目的: 分析同一术者行胫距跟(tibiotalocalcaneal, TTC)融合手术的患者临床资料，探讨患者临床结果、并发症和功能改善情况，分析TTC融合手术的临床预后及注意事项。方法: 回顾性分析2011年3月至2020年12月由同一术者行TTC融合手术治疗的40例患者的临床资料，其中男23例，女17例，平均年龄(49.1±16.0)岁，均为单侧手术。记录患者一般临床特征、影像学表现、主要诊断、具体手术方式。对比术前及末次随访时患者的美国足踝外科协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝-后足评分、疼痛视觉模拟评分(visual analogue scale，VAS)，记录融合愈合时间、症状较术前改善情况(明显改善、部分改善、无改善或恶化)以及术后并发症的发生情况。结果: 患者的术后中位随访时间为38.0(26.3, 58.8)个月；术前中位VAS评分为6.0(4.0, 7.0)分，中位AOFAS评分为33.0(25.3, 47.3)分；末次随访时患者的中位VAS评分为0(0, 3.0)分，中位AOFAS评分为80.0(59.0, 84.0)分；均较术前明显改善(P < 0.05)。所有患者均无切口坏死及感染，1例发生距下关节不愈合，为梅毒夏科氏(Charcot)关节，其余患者中位骨愈合时间为15.0(12.0, 20.0)周。所有患者中，较术前有明显改善者25例，部分改善者8例，改善不明显者4例，症状较术前加重者3例。结论: TTC融合术是治疗后足终末期病变的可靠方法，多数患者术后功能有改善，日常生活影响不大，预后差的原因包括足趾僵硬、邻近膝关节应力集中、不愈合及不明原因疼痛等。

关键词: 踝关节, 足, 胫距跟, 关节融合术, 治疗结果

Abstract:

Objective: To analyze the clinical data of patients with end-stage ankle and hindfoot arthropathy who underwent tibiotalocalcaneal (TTC) arthrodesis by the same surgeon, explore the short- and mid-term clinical results, complications and functional improvement, and discuss the clinical prognosis and precautions of TTC arthrodesis. Methods: Retrospective analysis was made on the clinical data of 40 patients who underwent TTC arthrodesis by the same surgeon from March 2011 to December 2020. In this study, 23 males and 17 females were included, with an average age of (49.1±16.0) years. All the patients underwent unilateral surgery. The clinical characteristics, imaging manifestations, main diagnosis and specific surgical techniques of the patients were recorded. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) between pre-operation and at the last follow-up. The fusion healing time, symptom improvement (significant improvement, certain improvement, no improvement or deterioration) and postoperative complications were also recorded. Results: The median follow-up time was 38.0 (26.3, 58.8) months. The preoperative VAS score was 6.0 (4.0, 7.0), and the AOFAS score was 33.0 (25.3, 47.3). At the last follow-up, the median VAS score was 0 (0, 3.0), and the AOFAS score was 80.0 (59.0, 84.0). All the significantly improved compared with their preoperative corresponding values (P < 0.05). There was no wound necrosis or infection in the patients. One patient suffered from subtalar joint nonunion, which was syphilitic Charcot arthropathy. The median bony healing time of other patients was 15.0 (12.0, 20.0) weeks. Among the included patients, there were 25 cases with significant improvement in symptom compared with that preoperative, 8 cases with certain improvement, 4 cases with no improvement, and 3 cases with worse symptoms than that before operation. Conclusion: TTC arthrodesis is a reliable method for the treatment of the end-stage ankle and hindfoot arthropathy. The function of most patients was improved postoperatively, with little impact on daily life. The causes of poor prognosis included toe stiffness, stress concentration in adjacent knee joints, nonunion and pain of unknown causes.

Key words: Ankle joint, Foot, Tibiotalocalcaneal, Arthrodesis, Treatment outcome

中图分类号:

R687.4

李文菁,张保宙,李恒,赖良鹏,杜辉,孙宁,龚晓峰,李莹,王岩,武勇. 胫距跟融合治疗终末期踝和后足病变的中短期临床结果[J]. 北京大学学报（医学版）, 2024, 56(2): 299-306.

Wenjing LI,Baozhou ZHANG,Heng LI,Liangpeng LAI,Hui DU,Ning SUN,Xiaofeng GONG,Ying LI,Yan WANG,Yong WU. Tibiotalocalcaneal arthrodesis for end-stage ankle and hindfoot arthropathy: Short- and mid-term clinical outcomes[J]. Journal of Peking University (Health Sciences), 2024, 56(2): 299-306.

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参考文献 23

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Items	Data (n=40)	P value
Age/years	49.1±16.0
Duration/months	33.0 (21.3, 106.0)
Union time/weeks	15.0 (12.0, 20.0)
Follow-up/months	38.0 (26.3, 58.8)
AOFAS		<0.001^*
Preoperative	33.0 (25.3, 47.3)
Postoperative	80.0 (59.0, 84.0)
VAS		<0.001^*
Preoperative	6.0 (4.0, 7.0)
Postoperative	0 (0, 3.0)
Maximal walking distance/m	3 000 (1 000, 3 000)
Maximal walking time/min	60 (30, 60)

Items	Group A + Group B (n=33)	Group C + Group D (n=7)	P value
Age/years	47.8±16.1	55.0±15.3	0.290^*
Duration/months	30.0 (17.5, 104.0)	48.0 (24.0, 120.0)	0.669^#
Union time/weeks	14.0 (12.0, 17.5)	20.0 (15.0, 36.0)	0.049^#
Follow up/months	39.0 (31.5, 66.0)	25.0 (17.0, 55.0)	0.170^#
AOFAS
Preoperative	37.0 (27.0, 49.0)	30.0 (20.0, 40.0)	0.262^#
Postoperative	81.0 (73.0, 84.0)	33.0 (27.0, 42.0)	<0.001^#
VAS
Preoperative	6.0 (4.0, 7.0)	6.0 (4.0, 9.0)	0.626^#
Postoperative	0 (0, 2.0)	5.0 (5.0, 8.0)	<0.001^#
Maximal walking distance/m	3 000 (1 000, 4 500)	30 (30, 100)	<0.001^#
Maximal walking time/min	60 (30, 60)	10 (5, 20)	<0.001^#