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前路双钢板行踝关节融合术的近期疗效

Short-term results of ankle arthrodesis using anterior double plating system

摘要:

目的 探讨前路双钢板行踝关节融合术的近期疗效.方法 自2009年9月至2011年10月采用前路双钢板行踝关节融合术治疗踝关节严重病损患者15例,男10例,女5例;年龄22 ~59岁,平均39.2岁.创伤性关节炎9例,骨关节炎3例,类风湿性关节炎3例.通过比较术前与末次随访时美国足踝外科协会(AOFAS)踝-后足评分评定疗效,术后根据踝关节X线检查观察融合情况. 结果 所有患者术后获9~18个月(平均13个月)随访.末次随访时全部踝关节均已骨性融合,融合时间9 ~ 28周,平均14周.AOFAS踝-后足评分由术前(36.1±8.1)分提高至末次随访时(82.7±6.3)分,差异有统计学意义(t=23.961,p=0.000).所有患者切口均I期愈合,无感染、局部皮肤坏死等并发症发生.至末次随访未出现螺钉、钢板松动、断裂等现象. 结论 利用踝关节前路双锁定钢板行踝关节融合术适用于病变严重、骨质缺损较多的患者,短期疗效确切.

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Objective To report short-term outcomes of ankle arthrodesis using anterior double plating system.Methods From September 2009 to October 2011,15 patients with end-stage arthritis of the ankle were treated by ankle arthrodesis with anterior double plating system in our department.They were 10 males and 5 females,aged from 22 to 59 years (average,39.2 years).Nine cases were post-traumatic arthritis,3 osteoarthritis and 3 rheumatoid arthritis.The ankle function was assessed preoperation and at the last follow-up in all patients according to the ankle and hindfoot scoring of American Orthopaedic Foot and Ankle Society (AOFAS); bone union was assessed by radiographs.Results The follow-up periods for the 15 patients lasted from 9 to 18 months (average,13 months).Bone union was obtained in all at the last follow-up.The fusion time ranged from 9 to 28 weeks (average,14 weeks).The mean AOFAS score increased significantly from preoperative 36.1 ± 8.1 points to 82.7 ± 6.3 points at the last follow-up (t =23.961,P =0.000).All the 15 patients achieved primary healing of incision and were free of complications like infection or local skin necrosis.No implant failure was observed at the last follow-up.Conclusions The anterior double plating system is an effective method to achieve solid ankle arthrodesis,with advantages of clear operative field,simplicity,rigid fixation and high fusion rate.Its short-term efficacy is definite particularly in patients with severe bone defect or loss of bone stock.

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