外侧入路锁定钢板与逆行髓内钉固定在胫距跟关节融合术中临床效果的比较

作者	单位	邮编
刘君^*	北京大学第一医院太原医院（太原市中心医院）骨科,山西太原,030009	030009
解晓融	山西医科大学第9临床医学院,山西太原,030009	030009
段英彪	祁县人民医院骨科,山西晋中,030999	030999
张超	北京大学第一医院太原医院（太原市中心医院）骨科,山西太原,030009	030009
史雪峰	北京大学第一医院太原医院（太原市中心医院）骨科,山西太原,030009	030009
胡鸿鹏	北京大学第一医院太原医院（太原市中心医院）骨科,山西太原,030009	030009
杜虎羽^*	北京大学第一医院太原医院（太原市中心医院）骨科,山西太原,030009	030009

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中文摘要:

目的比较胫距跟关节融合时应用外侧入路锁定钢板固定与逆行髓内钉固定的疗效。方法回顾性分析2021年6月至2023年5月于北京大学第一医院太原医院骨科行胫距跟关节融合术治疗的19例患者手术资料。其中，男13例，女6例；左侧7例，右侧12例。按手术方式不同分为两组，钢板组10例行外侧入路锁定钢板内固定术，髓内钉组9例行逆行髓内钉内固定术。比较两种固定方法的手术时间、术中出血量、术中透视次数、术后引流量和总住院时间；记录骨性融合率、骨性融合时间、术后并发症，术前及术后视觉模拟评分法（VAS）、美国足踝外科协会（AOFAS）的踝-后足功能评分、简明健康调查问卷（SF-36）评分。结果所有患者随访时间10～18个月，平均14.9个月。末次随访时两组患者骨性融合率均为100%，术后两组均未出现软组织感染、骨不连等并发症。髓内钉组在术中出血量、术后引流量及总住院时间方面均低于钢板组，但手术时间、术中透视次数多于钢板组，差异有统计学意义（P＜0.05）。术后4个月，钢板组的VAS评分高于髓内钉组，AOFAS评分低于髓内钉组，差异均有统计学意义（P＜0.05）；钢板组SF-36评分低于髓内钉组，差异无统计学意义（P＞0.05）。末次随访时，髓内钉组VAS评分低于钢板组，AOFAS和SF-36评分高于钢板组，差异无统计学意义（P＞0.05）。钢板组的骨性融合时间较髓内钉组长，差异有统计学意义（P＜0.05）。结论两种手术方式在胫距跟关节融合术中，均能实现胫距跟关节的有效内固定和理想的融合率，短期疗效无明显差异，临床医生可根据个人经验选择适宜的手术方式。

英文摘要:

Objective To evaluate and compare the outcomes of two surgical techniques—lateral locking plate fixation and retrograde intramedullary nailing—for tibiotalocalcaneal arthrodesis.Methods Clinical data from 19 patients undergoing the procedure between June 2021 and May 2023 were reviewed. Participants (13 males, 6 females; 7 left, 12 right ankles) were categorized into a plate group (n=10) receiving lateral locking plate fixation and a nail group (n=9) receiving retrograde intramedullary nailing. Recorded parameters included operative time, blood loss, fluoroscopy counts, postoperative drainage, length of hospital stay, time to bony fusion, complication rates, and pre-versus postoperative scores on the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, and the Short Form-36 (SF-36) health survey.Results Over a mean follow-up of 14.9 months (range 10-18 months), both groups achieved complete (100%) bony union with no instances of nonunion or surgical site infection. Statistically significant advantages (P<0.05) were observed for the nail group in reduced intraoperative blood loss, postoperative drainage, and shorter hospitalization, albeit with a longer operative time and a more intraoperative fluoroscopy times. At the four-month assessment, the nail group demonstrated significantly better VAS and AOFAS scores (P<0.05), while SF-36 scores showed no significant intergroup difference. By the final follow-up, although the nail group maintained superior trends in VAS, AOFAS, and SF-36 scores, these differences were no longer statistically significant (P>0.05). The plate group required a significantly longer time to achieve radiographic fusion compared to the nail group (P<0.05).Conclusion Both fixation methods are effective for tibiotalocalcaneal arthrodesis, yielding high fusion rates without major short-term complications. The choice of technique may be individualized based on specific perioperative priorities, as each approach offers distinct clinical advantages.

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