一期融合治疗踝及后足感染性关节炎

doi:10.19723/j.issn.1671-167X.2026.04.022

摘要/Abstract

摘要：

目的: 评估一期清创、关节融合、Ilizarov外固定架固定治疗踝及后足感染性关节炎的临床效果。方法: 选择2015年4月至2023年6月北京积水潭医院足踝外科由同一术者行一期清创、关节融合、Ilizarov外固定架固定手术治疗的12例踝关节及后足感染性关节炎患者的临床资料进行回顾性分析，其中男8例，女4例；手术时平均年龄为(53.6±16.2)岁，均为单侧手术。记录患者一般临床特征、细菌培养结果和拆除外固定架时间，记录并比较患者术前及末次随访时美国足踝外科协会(American Orthopaedic Foot and Ankle Society, AOFAS)踝-后足评分和疼痛视觉模拟评分(visual analogue scale，VAS)，记录患者对手术的满意度以及并发症发生情况。结果: 所有患者术后平均随访(51.3±34.0)个月，其中细菌培养阳性7例。所有患者感染均得到控制，骨愈合率100%，中位外固定架拆除时间16(12，24)周。术前，中位VAS评分7(5.3，7.8)分，平均AOFAS踝-后足评分(42.8±10.4)分；末次随访时，中位VAS评分1(0，2)分，平均AOFAS踝-后足评分(77.6±10.2)分，均较术前显著改善(P＜0.01)。并发症方面，针道感染1例，肢体短缩3例，肢体麻木2例。12例患者9例对手术非常满意，3例对手术满意。结论: 一期清创、关节融合、Ilizarov外固定架固定是治疗踝及后足感染性关节炎的可靠方法，能有效控制感染，缩短治疗时间，且患者术后功能恢复及影像学结果良好。

关键词: 感染性关节炎, 踝关节, 后足, 一期手术, 融合

Abstract:

Objective: To evaluate the clinical outcomes of one-stage debridement, arthrodesis, and Ilizarov external fixation for the treatment of septic arthritis of the ankle and hindfoot. Methods: A retrospective analysis was conducted on 12 patients with septic arthritis of the ankle or hindfoot who underwent one-stage debridement, arthrodesis, and Ilizarov external fixation performed by the same surgeon between April 2015 and June 2023. The study included 8 males and 4 females, with a mean age of (53.6±16.2) years at surgery; all procedures were unilateral. General clinical characteristics, bacterial culture results, and the time to external fixator removal were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) for pain were recorded and compared between the preoperative period and the final follow-up. Patient satisfaction with the surgery and the occurrence of complications were also documented. Results: All patients were followed up for a mean of (51.3±34.0) months postoperatively. Positive bacterial cultures were found in 7 cases. Infection control was achieved in all patients, with a 100% bone fusion rate confirmed by radiographs or CT. The median time to external fixator removal was 16 (12, 24) weeks. Preoperatively, the median VAS score was 7 (5.3, 7.8) points, and the mean AOFAS ankle-hindfoot score was (42.8±10.4) points. At the final follow-up, the median VAS score was 1 (0, 2) point, and the mean AOFAS score was (77.6±10.2) points, both showing significant improvement compared with preoperative values (P < 0.01). Regarding complications, there was 1 case of pin tract infection, 3 cases of limb shortening, and 2 cases of skin numbness. Nine patients were very satisfied with the surgery, and 3 were satisfied. Conclusion: One-stage debridement, arthrodesis, and Ilizarov external fixation are a reliable method for treating septic arthritis of the ankle and hindfoot. It effectively controls infection, shortens treatment duration, and yields favorable functional and imaging outcomes, with high patient satisfaction and acceptable complication rates.

Key words: Septic arthritis, Ankle, Hindfoot, Single-stage procedure, Arthrodesis

中图分类号:

R684.3

王执宇, 李文菁, 张保宙, 李莹, 杜辉, 王岩, 武勇. 一期融合治疗踝及后足感染性关节炎[J]. 北京大学学报（医学版）, 2026, 58(4): 842-847.

Zhiyu WANG, Wenjing LI, Baozhou ZHANG, Ying LI, Hui DU, Yan WANG, Yong WU. Single-stage arthrodesis for septic arthritis of the ankle and hindfoot[J]. Journal of Peking University (Health Sciences), 2026, 58(4): 842-847.

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参考文献 20

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Parameters	Preoperative	Final follow-up	Statistic	P value
AOFAS ankle-hindfoot score，$\bar{x} \pm s$	42.8±10.4	77.6±10.2	t=-6.952	＜0.001
VAS score，M(P₂₅, P₇₅)	7.0 (5.3, 7.8)	1.0 (0, 2.0)	Z=-3.074	0.002