中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (6): 839-842.doi: 10.3969/j.issn.2095-4344.2426

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

改良滑槽植骨术加空心螺钉固定行胫距关节融合的有效性及安全性

韩昕光1，尹志江2，王祥成2，杨晨雨2，尚  剑1   

  1. 1哈尔滨医科大学附属第一医院骨一科，黑龙江省哈尔滨市  150001；2齐齐哈尔市第一医院骨二科，黑龙江省齐齐哈尔市  161000
  • 收稿日期:2019-04-20 修回日期:2019-04-20 接受日期:2019-06-14 出版日期:2020-02-28 发布日期:2020-01-16
  • 通讯作者: 尚剑，博士，主任医师。哈尔滨医科大学附属第一医院骨一科，黑龙江省哈尔滨市 150001
  • 作者简介:韩昕光，男，1975年生，辽宁省辽阳市人，汉族， 2008年哈尔滨医科大学毕业，博士，副主任医师。
  • 基金资助:
    黑龙江省教育厅科学研究项目(12541359)

Effectiveness and safety of modified sliding chute bone graft plus hollow screw fixation for tibiotalar joint fusion

Han Xinguang1, Yin Zhijiang2, Wang Xiangcheng2, Yang Chenyu2, Shang Jian1   

  1. 1First Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China; 2Second Department of Orthopedics, the First Hospital of Qiqihar, Qiqihar 161000, Heilongjiang Province, China
  • Received:2019-04-20 Revised:2019-04-20 Accepted:2019-06-14 Online:2020-02-28 Published:2020-01-16
  • Contact: Shang Jian, MD, Chief physician, First Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
  • About author:Han Xinguang, MD, Associate chief physician, First Department of Orthopedics, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
  • Supported by:
    the Research Project of Education Department of Heilongjiang Province, No. 12541359

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摘要：

文题释义：
踝关节：属滑车关节，可沿通过横贯距骨体的冠状轴做背屈及跖屈运动。
植骨融合：是一种为由外伤引起的上、下颌骨的骨折而制定的技术，能达到完全性骨性愈合的效果。

背景：胫距关节融合术式很多，针对伴有距骨坏死的患者融合难度较大，但各种术式植入物的修复效果比较的研究少见报道。

目的：比较改良滑槽植骨术加空心螺钉固定与单纯螺钉内固定、钢板内固定术行胫距关节融合的疗效及安全性。

方法：收集接受胫距关节融合修复的患者56例，其中应用螺钉内固定16例、钢板内固定22例与改良滑槽植骨术加空心螺钉固定18例。比较3种术式修复后患者足踝功能，采用美国足踝外科协会踝后足评分系统评估，同时比较3种术式的手术时间、支具固定时间和融合时间，末次随访的步态。患者平均随访时间2.4年。试验符合哈尔滨医科大学附属第一医院对研究的相关伦理要求，参与试验的患病个体及其家属为自愿参加，对试验过程完全知情同意，均签署知情同意书。

结果与结论：①全部患者踝关节均得到确切骨性融合，滑槽植骨组与传统钢板固定组在融合时间及末次步态均明显改善(P < 0.05)，螺钉固定组在手术时间上有优势(P < 0.05)；②采用美国足踝外科协会踝后足评分系统评估，滑槽植骨组与传统钢板固定之间无显著差异，但均明显优于螺钉固定组(P < 0.05)；③各组末次随访均未发现不良反应病例；④结果证实，改良滑槽植骨术加空心螺钉固定行踝关节融合术，与单纯螺钉固定相比，有效提高了踝关节融合率，安全有效。

ORCID: 0000-0002-8182-3476(韩昕光)

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: 滑槽植骨, 改良, 胫距关节, 融合术, 空心螺钉, 钢板, 距骨坏死, 固定效果, 足踝功能

Abstract:

BACKGROUND: Tibiotalar joint fusion ways are various, and it is a difficulty in necrotic tibiotalar joint fusion. There are few comparative studies on the repair outcomes of each implant.

OBJECTIVE: To compare the effectiveness and safety of modified sliding chute bone graft plus hollow screw fixation with simple screw internal fixation and plate internal fixation for tibiotalar joint fusion.

METHODS: Fifty-six patients who underwent tibiotalar joint fusion were included, including 16 cases of screw fixation, 22 cases of plate fixation and 18 cases of modified sliding chute bone graft plus hollow screw fixation. Ankle function was compared after simple screw internal fixation, plate internal fixation and modified sliding chute bone graft plus hollow screw fixation. The ankle foot scoring system of American Orthopedic Foot and Ankle Society was used for evaluation. At the same time, the operation time, brace fixation time and fusion time of the three surgical methods were compared. The gait at the last follow-up was compared. The average follow-up time was 2.4 years. The experiment met the ethical requirements of the First Affiliated Hospital of Harbin Medical University. All patients provided written informed consent for study participation.

RESULTS AND CONCLUSION: (1) All the patients obtained exactly bony fusion. Compared with the plate fixation group, the slide bone grafting group had significant advantages in the fusion time and the last gait (P < 0.05), and the screw fixation group had significant advantages in the operation time (P < 0.05). (2) Using the ankle foot scoring system of American Orthopedic Foot and Ankle society, there was no significant difference between the sliding chute bone graft group and the plate fixation group, but both groups were significantly better than the screw fixation group (P < 0.05). (3) Adverse events had not been found in each group. (4) These results suggest that modified sliding chute bone graft plus hollow screw fixation for ankle joint fusion can effectively improve ankle joint fusion rate compared with single screw fixation, which is effective and safe.

Key words: sliding chute bone graft, modified, tibiotalar joint, fusion, hollow screw, plate, talus osteonecrosis, fixation outcomes, ankle function

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