摘要目的 观察踝上截骨术治疗踝关节2期创伤性关节炎的疗效.方法 自2005年10月至2008年5月对47例踝火节2期创伤性关节炎行踝上截骨术治疗,31例获得完整随访.12例行开放性楔形截骨术,其中10例胫骨内侧开放件楔形截骨术即时矫正踝关节内翻,此间有3例在即时矫正内翻的同时行跗管松解术,2例因踝关节严重内翻畸形愈合,截骨同时在Ilizarov治疗器下缓慢牵张矫正原始畸形愈合;19例行腓骨退旋延长术.采用美国骨科足踝外科协会(AOFAS)踝关节功能评分系统进行评分.结果 31例获得12～43个月(平均27.3个月)随访.骨折全部愈合,临床愈合时间平均为13.3周(11～17周),完全负重时间平均为14.1周(12～19周).术后12个月踝火节AOFAS评分为63～92分,平均84.3分,其中优14例,良11例,一般6例,优良率80.6%.术后2例出现内侧切口裂开,1例发生内侧切口皮缘部分坏死,均经换药保守治疗痊愈.3例术后出现足外侧皮肤感觉麻木,2例患者在最近随访时X线片示关节炎有轻微进展,予以关节腔注射施沛特保守治疗后而无需手术即获得了满意的临床效果.无螺钉松动、断裂及内固定失效等其他并发症.结论 采用踝上截骨术治疗踝关节2期创伤性关节炎,近期可获得满意效果.

abstractsObjective To investigate the therapeutic effects of supramalleolar ostentomv for secondary traumatic arthritis of the ankle joint Methods Forty-seven patients with secondary traumatic arthritis of theankle joint were admitted to our hospital from October 2005 to May 2008.Only 31 patients of them who had been available to complete follow-up were included in this study.Ofthem,12 underwent open wedge-shaped osteotomy and theother 19 thelengtheningosteotomy of the fibula.Inopenwedge-shapedosteotomy,10 caseshad correction of the varus deformity of the ankle instantly during the operation,3 of whomalso received the releasing of tarsal tunnel at the sametime,whilethe other 2 ankles were treated with the Ilizarov external fixator to correct the malformation gradually due to severe varns deformity.The functions of the ankle were assessed by the American Orthopaedic Foot&Ankle Society(AOFAS)scoring system Results Ameanfollow-up of 27.3(12to43)months showed that all the fractures were healed in a mean time of 13.3(11 to 17)weeks Themean time for total weight-bearing was 14.1(12to 19)weeks.The mean AOFAS score of the ankle function 12 months after the operation was 84.3.There were 14excellent cases,11 good and 6 fair ones(good to excellent rate:80.6%).After the operation,2 patients had wound disruption and 1 patient skin necrosis around the wound.Anaesthesia on the lateral side of the foot happened in 3 patients,and a slightly aggravated degeneration of the ankle joint in 2 patients.All complications responded to conservative managements.No failure of the internal fixation was noted in this group. Conclusion Supramaileolar osteotomy can lead to a good outcome in the early postoperative period for the secondary Iraumatic arthritis of the ankle joint.