| 带血供腓骨瓣踝外侧结构支撑技术行胫距跟融合术治疗踝骨关节炎的临床疗效 |
| The clinical efficacy of tibiotalocalcaneal fusion using the vascularized fibula flap for lateral column support in the treatment of ankle osteoarthritis |
| 投稿时间：2024-07-15 |
| DOI：10.3969/j.issn.1672-5972.2025.03.009 |
| 中文关键词: 带血供腓骨瓣 胫距跟融合 踝关节 骨性关节炎 空心拉力螺钉 |
| 英文关键词:Vascularized fibula flap Tibiotalocalcaneal fusion Ankle joint Osteoarthritis Cannulated compression screw |
| 基金项目:湖北民族大学附属民大医院开放课题临床研究中心一般项目（OIR202305Y） |
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| 中文摘要: |
| 目的 观察并分析带血供腓骨瓣踝外侧结构支撑技术行胫距跟（tibiotalocalcaneal, TTC）融合术的临床效果、功能恢复及并发症的情况，为临床治疗提供新的思考。方法 回顾性分析2020年1月至2023年3月湖北民族大学附属民大医院收治并完成12个月随访的43例终末期踝骨关节炎的临床资料。复查踝关节正侧位片确认踝关节融合情况及融合时间，观察踝周血运情况及血管增生情况。记录术前、术后VAS评分评估疼痛情况，记录AOFAS评分评估功能情况，评价踝关节功能优良率，比较术前术后炎症因子检验值变化，记录术后并发症情况。结果 ①患者术后均接受12个月随访，术后复查踝关节正侧位片，3个月时有38例完全融合；术后多普勒超声复查显示，患肢踝周血运良好，腓骨瓣局部有代偿性的血管增生；②术后VAS评分、AOFAS评分较术前明显改善（P＜0.05），12个月时踝关节功能优良率100%；③术后炎症因子较术前明显改善（P＜0.05）；④有3例术后6个月随访时未完全融合，有1例术后12个月随访时未完全融合；⑤有1例肥胖患者术后切口愈合不良，经对症治疗后好转。结论 带血供腓骨瓣踝外侧结构支撑技术行胫距跟融合治疗终末期踝关节骨关节炎，可有效改善局部血运，提高融合效果及融合时间，促进患肢踝关节功能恢复，并发症少，值得临床推广。 |
| 英文摘要: |
| Objective To observe and analyze the clinical outcomes, functional recovery, and complications of tibiotalocalcaneal (TTC) fusion surgery using vascularized fibula flap lateral column support for the treatment of end-stage ankle osteoarthritis, and to provide new references for clinical treatment.Methods A retrospective analysis was conducted on the clinical data of 43 patients with end-stage ankle osteoarthritis who were treated and followed up for 12 months at Affiliated Hospital of Hubei Minzu University from January 2020 to March 2023. The fusion status and time were confirmed by re-examination of anteroposterior and lateral ankle radiographs, and the vascularization around the ankle and vascular proliferation were observed. Pain was assessed using the VAS score before and after surgery, and function was evaluated using the AOFAS score. The excellent and good rates of ankle function were evaluated, changes in preoperative and postoperative inflammatory markers were compared, and postoperative complications were recorded.Results ①All patients were followed up for 12 months. Re-examination of anteroposterior and lateral ankle radiographs at 3 months postoperatively showed complete fusion in 38 cases. Doppler ultrasound re-examination showed good blood supply around the ankle and compensatory vascular proliferation in the fibula flap. ②Postoperative VAS scores and AOFAS scores were significantly improved compared to preoperative scores (P<0.05), with a 100% excellent and good rate of ankle function at 12 months after surgery. ③Postoperative inflammatory markers were significantly improved compared to preoperative levels (P<0.05). ④Three cases had incomplete fusion at 6-month follow-up, and one case had incomplete fusion at 12-month follow-up. ⑤One obese patient had poor incision healing postoperatively, which improved after symptomatic treatment.Conclusion Tibiotalocalcaneal fusion using vascularized fibula flap lateral column support for the treatment of end-stage ankle osteoarthritis can effectively improve local blood supply, enhance fusion outcomes and fusion time, promote the recovery of ankle function, and have few complications, making it worthy of clinical promotion. |
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