中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (4): 588-593.doi: 10.12307/2022.961

• 骨科植入物 orthopedic implant • 上一篇    下一篇

带血供腓骨瓣与空心螺钉胫距跟融合治疗终末期踝关节炎

于  鹤,郑加法,宋秀锋,关盛溢   

  1. 大连市第二人民医院足踝外科,辽宁省大连市   116000
  • 收稿日期:2021-12-09 接受日期:2022-01-17 出版日期:2023-02-08 发布日期:2022-06-23
  • 通讯作者: 宋秀锋,硕士,主任医师,主任,大连市第二人民医院足踝外科,辽宁省大连市 116000
  • 作者简介:于鹤,男,1986年生,吉林省人,汉族,2015年大连医科大学毕业,硕士,主治医师,主要从事足踝外科方面的研究。
  • 基金资助:
    大连市科技创新基金(2021JJ13SN54),项目负责人:于鹤

Tibiotalocalcaneal arthrodesis with blood supplied fibular flap combined with hollow screw in the treatment of end-stage ankle osteoarthritis

Yu He, Zheng Jiafa, Song Xiufeng, Guan Shengyi   

  1. Department of Ankle Surgery, Dalian No. 2 People’s Hospital, Dalian 116000, Liaoning Province, China
  • Received:2021-12-09 Accepted:2022-01-17 Online:2023-02-08 Published:2022-06-23
  • Contact: Song Xiufeng, Master, Chief physician, Department of Ankle Surgery, Dalian No. 2 People’s Hospital, Dalian 116000, Liaoning Province, China
  • About author:Yu He, Master, Attending physician, Department of Ankle Surgery, Dalian No. 2 People’s Hospital, Dalian 116000, Liaoning Province, China
  • Supported by:
    Dalian Science and Technology Innovation Fund, No. 2021JJ13SN54 (to YH)

摘要:

文题释义:
经腓骨门入路:在腓骨外侧入路的基础上进行改良,保留了外侧腓骨瓣以及此处良好的血运,促进融合关节愈合。
带血供腓骨瓣:带血供腓骨瓣植入受区后,改变了无血供腓骨瓣移植爬行替代模式,提高了骨细胞存活率,改善患侧血供,促进骨愈合,与单纯腓骨瓣移植相比其愈合时间更短。

背景:既往研究报道腓骨瓣支撑结合空心螺钉行胫距跟融合治疗踝关节骨性关节炎有确切效果,但所用腓骨瓣未带血供,在一定程度上影响局部血运恢复。此次研究利用腓骨远端良好血运,对腓骨瓣支撑结合空心螺钉胫距跟融合进行改良,探讨改良术式治疗踝关节骨性关节炎的临床效果。
目的:探讨经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗终末期踝关节骨性关节炎的临床疗效,以及对患肢生物力学的影响。
方法:回顾分析2018年1月至2020年10月大连市第二人民医院收治的30例终末期踝关节骨性关节炎患者,均择期实施经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗。术后接受12个月随访,观察术后腓骨远端局部血运状况及切口Ⅰ期愈合情况;术后复查踝关节CT,评估骨愈合时间;应用步态分析仪及足底压力测量系统评估术后恢复情况,掌握术后并发症。
结果与结论:①患者术后均接受12个月随访,无失访病例;术后多普勒血管探测仪及下肢血管CT血管造影复查显示,患肢血管蒂和腓后动脉穿支及伴行静脉吻合,局部血运良好,切口均为Ⅰ期愈合;②术后复查踝关节CT,融合处骨性愈合时间为8-13周,平均(10.70±2.13)周;③术后3个月患者的步长、步速及步频均较术前显著提升,差异有显著性意义(P < 0.05);④通过足底压力测量系统测定分析,术后6个月患者自然行走中,患侧足底第2-4跖骨区、中足、足跟内侧、足跟外侧、全足底的压力值均低于术前,差异有显著性意义(P < 0.05);⑤术后随访,1例患者出现腓肠神经损伤症状,在对症治疗后消失;⑥患者踝关节功能恢复优良率为100%;⑦提示经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗终末期踝关节骨性关节炎,可有效改善局部血运,提高融合效果,促进患肢踝关节功能恢复,有重要的临床意义。

https://orcid.org/0000-0002-2108-7868 (于鹤)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 带血供腓骨瓣, 空心螺钉, 胫距跟融合, 踝关节, 骨性关节炎, 局部血运, 骨愈合, 足底压力

Abstract: BACKGROUND: Previous studies have reported that tibiotalocalcaneal arthrodesis via fibular flap support combined with hollow screw has a definite effect in the treatment of ankle osteoarthritis, but the fibular flap does not have blood supply, which affects the recovery of local blood circulation to a certain extent. In this study, the tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screw was improved by using the good blood supply of the distal fibula, and the clinical effect of the improved operation in the treatment of ankle osteoarthritis was discussed. 
OBJECTIVE: To investigate the biomechanical effects on affected limbs and the clinical effect of tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screw for ankle osteoarthritis.
METHODS: From January 2018 to October 2020, 30 patients with severe ankle osteoarthritis in Dalian No. 2 People’s Hospital were included in this study, and all patients underwent tibiotalocalcaneal arthrodesis via fibular portal with blood supplied fibular flap combined with hollow screws. After 12 months of follow-up, local blood circulation of distal fibula and the stage I healing of the incision were observed, and the ankle CT was reviewed postoperatively to evaluate the time of bone healing. The postoperative recovery was evaluated by gait analyzer and plantar pressure measurement system and the postoperative complications were mastered.
RESULTS AND CONCLUSION: (1) All patients were followed up for 12 months after operation, and no case of loss to follow-up was found. Postoperative Doppler angiography showed that the vascular pedicle of the affected limb and perforating branches of the posterior peroneal artery were accompanied by venous anastomosis; local blood circulation was good; and the incisions were all in stage I healing. (2) After surgery, the ankle CT examination showed that the bone healing time at the fusion site was 8-13 weeks, with a mean of (10.70±2.13) weeks. (3) At 3 months after surgery, the patients’ step length, step speed and step frequency were significantly higher than those before surgery (P < 0.05). (4) According to the measurement of plantar pressure measurement system, the pressure values of the second metatarsal area, the third metatarsal area, the fourth metatarsal area, the middle foot, the medial heel, the lateral heel and the whole plantar of the affected side were significantly lower than the preoperative values during the natural walking at 6 months after surgery (P < 0.05). (5) During the postoperative follow-up, one case showed sural nerve injury symptoms, which disappeared after symptomatic treatment. (6) The excellent and good rate of ankle function recovery was 100%. (7) Above results have confirmed that the treatment of ankle osteoarthritis by tibiotalocalcaneal arthrodesis with blood supplied fibula flap combined with hollow screw through fibula portal approach can effectively improve local blood circulation, improve fusion effect and promote the recovery of ankle function of the affected limb, which has an important clinical significance. 

Key words: fibula flap with blood supply, hollow screw, tibiotalocalcaneal arthrodesis, ankle, osteoarthritis, local blood circulation, bone healing, plantar pressure

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