本文選題：踝關節(jié)炎 + 踝上截骨��； 參考：《新疆醫(yī)科大學》2017年碩士論文

【摘要】：目的:對比踝上截骨鋼板內固定術與踝上截骨聯(lián)合Ilizarov架牽伸治療內翻型踝關節(jié)炎臨床療效。方法:收集2015年2月至2017年2月在我院骨病矯形外科手術治療的41例內翻型踝關節(jié)炎患者的完整臨床資料,采用回顧性研究方法,將不同治療方式的患者分為A、B兩組,其中A組采用踝上截骨解剖鋼板內固定;B組采用踝上截骨法聯(lián)合Ilizarov技術外固定。A組21例,術前AOFAS-HA評分46.71±9.30;B組20例,術前AOFAS-HA評分45.92±8.91。統(tǒng)計A、B組病例的手術時間、出血量、術前術后影像學改變、術后并發(fā)癥發(fā)生率的差異。術后3個月、6個月、12個月時,采用AOFAS-HA評分對患者進行療效評價,于術后6個月測量TAS、TLS值。結果:A組(鋼板固定組)手術時間(75.50±24.36)min,術中出血量(100.30±30.36)ml;A組21例,隨訪時間3~24個月,平均(14.8±3.1)個月。B組(Ilizarov牽張固定組)手術時間(60.10±23.55)min,出血量(70.70±40.12)ml;B組2 0例,隨訪時間3~24個月,平均(13.6±1.5)個月。兩組手術時間、術中出血量,術后并發(fā)癥,比較差異有統(tǒng)計學意義,TAS、TLS值無統(tǒng)計學意義。術后A組6例出現(xiàn)并發(fā)癥,B組3例出現(xiàn),兩組比較差異具有統(tǒng)計學意義。術后3個月AOFAS-HA評分無統(tǒng)計學意義。術后6月AOFAS-HA評分A組(70.15±1.32),B組(75.35±1.16),具有統(tǒng)計學意義。術后12個月時,A組AOFAS-HA評分為(83.45±1.59),B組為(83.15±1.95),兩組比較差異無統(tǒng)計學意義(t=-7.21,P0.05)。結論:踝上截骨聯(lián)合Ilizarov牽張外固定技術較踝上截骨鋼板內固定術,有創(chuàng)傷小,出血少,術后并發(fā)癥少,可以改善近期患者的踝關節(jié)功能,遠期TAS、TLS、AOFAS-HA評分值并無明顯差異。兩種手術均能有效改善內翻型踝關節(jié)炎臨床癥狀。
[Abstract]:Objective: to compare the clinical effect of supramalleolar osteotomy with plate fixation and supramalleolar osteotomy combined with Ilizarov frame in the treatment of varus ankle arthritis. Methods: the complete clinical data of 41 patients with varus ankle arthritis treated by orthopaedic surgery from February 2015 to February 2017 in our hospital were collected. In group A, 21 cases were treated with supramalleolar osteotomy combined with Ilizarov technique, 20 cases in group B were treated with supramalleolar osteotomy and external fixation with Ilizarov technique, 20 cases in group B were treated with supramalleolar osteotomy and internal fixation with anatomical plate, and the preoperative AOFAS-HA score was 45.92 鹵8.91 in group B. The time of operation, the amount of blood loss, the imaging changes before and after operation, and the incidence of postoperative complications were analyzed. At 3 months, 6 months and 12 months after operation, AOFAS-HA score was used to evaluate the curative effect of the patients, and the TLS value was measured 6 months after operation. Results the operative time was 75.50 鹵24.36 min in group A (plate fixation group), and the intraoperative bleeding volume was 100.30 鹵30.36 ml / min in group A. The follow-up time was 3 ~ 24 months (mean 14.8 鹵3.1) months. The operation time of group B was 60.10 鹵23.55 min, and the volume of blood loss was 70.70 鹵40.12 ml / ml group B (n = 20). The follow-up time was 3 ~ 24 months, with an average of 13.6 鹵1.5 months. There was no significant difference in the time of operation, the amount of intraoperative bleeding and postoperative complications between the two groups. Postoperative complications occurred in 6 cases in group A and 3 cases in group B, and the difference was statistically significant between the two groups. There was no significant difference in AOFAS-HA score 3 months after operation. The AOFAS-HA score of group A was 70.15 鹵1.32 鹵75.35 鹵1.16, which was statistically significant 6 months after operation. At 12 months after operation, the AOFAS-HA score of group A was 83.45 鹵1.59m and that of group B was 83.15 鹵1.95.There was no significant difference between the two groups (P 0.05). Conclusion: the technique of supramalleolar osteotomy combined with Ilizarov distraction external fixation has less trauma, less bleeding and less postoperative complications than that of internal fixation with supramalleolar osteotomy plate. It can improve the function of ankle joint in the near future, and there is no significant difference in the long-term TASS-TLSAOFAS-HA score. Both operations can effectively improve the clinical symptoms of varus ankle arthritis.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.4

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