骨赘清理结合Ilizarov关节牵伸术治疗中晚期踝关节炎
郭保逢;秦泗河;任龙喜;赵巍;吴鸿飞;郑学建;石磊;梁喜斌;
摘要(Abstract)：
[目的]探讨骨赘清理结合Ilizarov关节牵伸术治疗中晚期踝关节炎的临床疗效。[方法]回顾性分析2009年10月~2014年12月本科收治的9例中晚期踝关节炎的病例,女6例,男3例;年龄20~45岁,平均34.2岁。均为单侧发病。踝关节创伤病史5例,脊髓灰质炎后遗症足部矫形术后病史3例,无足部相关疾病史者1例。采用切开清除踝关节骨赘,然后安装术前已组装好的Ilizarov踝关节牵伸外固定器,术后逐渐牵伸并维持踝关节间隙5~8 mm负重行走。采用AOFAS踝-后足评分评价临床疗效。[结果]9例患者获得随访,末次随访时间为术后12~60个月,平均29.4个月。术后佩戴外固定器时间12~24周,平均16周。末次随访时AOFAS踝-后足评分76~89分,平均(81±7.2)分,较术前29~48分,平均(34.6±4.9)分,差异有统计学意义。未出现严重并发症。5例随访过程中出现轻中度外固定针道感染,给予局部酒精敷料包扎结合口服抗生素后控制。1例足跟固定针折断,未予特殊处理,拆除外固定装置时拔除。[结论]骨赘清理术结合Ilizarov关节牵伸术治疗中晚期踝关节炎是一种简单有效的方法,创伤小,能延缓关节置换或踝关节融合时间。
关键词(KeyWords)： 骨赘清理术;Ilizarov技术;关节牵伸术;踝骨性关节炎
基金项目(Foundation): 首都临床特色应用研究课题(编号:Z141107002514038)
作者(Author): 郭保逢;秦泗河;任龙喜;赵巍;吴鸿飞;郑学建;石磊;梁喜斌;
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参考文献(References)：
- [1]赵宏谋,杨云峰,俞光荣.全踝关节置换并发症的meta分析[J].中华外科杂志,2011,49(8):737-740.
- [2]Chu CR,Williams AA,Coyle CH,et al.Early diagnosis to enable early treatment of pre-osteoarthritis[J].Arthritis Res Ther,2012,14(3):212.
- [3]秦泗河,蔡刚,葛建忠.关节牵伸术在下肢骨性关节炎中的治疗作用[J].中华外科杂志,2010,48(2):146-148.
- [4]Saltzman CL,Hillis SL,Stolley MP,et al.Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis:a prospective randomized controlled trial[J].J Bone Joint Surg Am,2012,94(11):961-70
- [5]Aldegheri R,Trivella G,Saleh M.Articulated distraction of the hip:conservative surgery for arthritis in young patients[J].Clin Orthop,1994,301:94-101.
- [6]Liu Y,Buckley CT,Downey R,et al.The role of environmental factors in regulating the development of cartilaginous grafts engineered using osteoarthritic human infrapatellar fat pad-derived stem cells[J].Tissue Eng Part,2012,18(15):1531-1541.
- [7]Burr DB,Gallant MA.Bone remodelling in osteoarthritis[J].Nat Rev Rheumatol,2012,8(11):665-673.
- [8]郑学建,秦泗河,郭保逢,等.Ilizarov踝关节弹性斜拉牵伸器在矫治重度马蹄足中的应用[J].中华创伤骨科杂志,2015,17(12):1035-1041.
- [9]Burr DB,Gallant MA.Bone remodelling in osteoarthritis[J].Nat Rev Rheumatol,2012,8(11):665-673.
- [10]Juhasz T,Matta C,Somogyi C,et al.Mechanical loading stimulates chondrogenesis via the PKA/CREB-Sox9 and PP2A pathways in chicken micromass cultures[J].Cell Signal,2014,26(3):468-482.
- [11]Morse KR,Flemister AS,Baumhauer JF,et al.Distraction arthroplasty[J].Foot Ankle Clin,2007,12(1):29-39.
- [12]Fragomen AT,Mc Coy TH,Meyers KN,et al.Minimum distraction gap:how much ankle joint space is enough in ankle distraction arthroplasty[J].HSS J,2014,10(1):6-12.