摘要目的 探讨老年晚期踝关节炎的特点和评价经外踝截骨螺钉固定的踝关节融合术手术疗效.方法 回顾性分析2010年1月至2015年6月烟台市烟台山医院骨科足踝外科治疗并获完整随访的33例老年晚期踝关节炎患者.合并1种或多种慢性内科基础疾病25例(75.8%).有踝关节创伤病史26例(78.8%).根据Takakura-Tanaka踝关节炎分期标准分期.手术方法为经外踝截骨螺钉固定的踝关节融合术.统计患者的术后主观满意度.采用美国足踝外科协会(AOFAS)及视觉模拟评分(VAS)评价术前及末次随访时足踝部功能.结果 33例患者获得12~49个月随访.31例(93.9%)主观满意.AOFAS和VAS评分分别由术前(50.9±12.0)、(6.1±1.7)分改善为末次随访(78.8±9.6)、(1.7±1.1)分(P<0.05).7例患者术后发生切口并发症.27(81.8%)例患者经CT证实完全骨性融合,4例患者部分骨性融合但达到负重要求,另外2例不融合.结论 老年晚期踝关节炎患者大多有陈旧性踝关节外伤病史且合并慢性内科基础疾病,经外踝截骨螺钉固定的踝关节融合术疗效较好,但需注意切口和骨愈合相关并发症.

abstractsObjective To evaluate the Treatment effect of geriatric ankle osteoarthritis by arthrodesis with screw fixation through lateral malleolus osteotomy .Methods Thirty-three patients with severe osteoarthritis according to the classification of Takakura-Tanakawere treated by ankle arthrodesis through lateral malleolus osteotomy with screw fixation from January 2010 to June 2015.Twenty-five patients were combined with more than 1 internal diseases.Twenty-six patients owned ankle injury history .Clinical and radiologic evaluations were performed before surgery and at the most recent follow-up.Results The American Orthopaedic Foot and Ankle Society scale was (50.9 ±12.0) points beforesurgery and (78.8 ± 9.6) points at the most recent follow-up ( P<0.01 ) .The visual analogue scalein last follow up was significantly decreased to (1.7 ±1.1), compared with (6.1 ±1.7) preoperatively.Seven patients were accompanied with incision complications .27 patients(81.8 percent) reached complete solid fusion , which was confirmed by CT.4 patients was partially bony fused , which could also perform weight-bearing walk. The other 2 patients with nonunion were reoperated lastly .Conclusions Ankle arthrodesis by screw fixation through lateral malleolus osteotomy is the preferable surgical treatment option in patients with end -stage geriatric ankle arthritis,showing high reliability and effectivity in pain relieving and function improvement . Incision and bony healing complications should draw attention especially in patients combined with internal disease.