目的 探讨腓骨支撑踝关节融合术治疗大骨节病性距骨坏死的效果.方法 选择2012年1月～2016年1月于陕西省宝鸡市中医医院骨科住院的大骨节病性距骨坏死患者45例,给予腓骨支撑踝关节融合术.记录研究对象的随访情况;摄踝关节正侧位X线片,观察骨融合情况,并行组织学观察;分别在术前及术后6、12个月随访,比较骨密度(BMD)、最大抗压缩强度及美国足踝外科协会(AOFAS)评分.结果 所有患者术后均全部获得随访,平均(8.5±1.1)个月.切口均于术后2周拆线.X线片示术后4周骨痂形成;术后5周患者疼痛减轻,足部外形改善.样本BMD检测及相应的生物力学检测结果显示,术后BMD及最大抗压缩强度均有所增大,差异有统计学意义(P＜0.05).不同时间段AOFAS评分,差异有统计学意义(P＜0.05).结论 腓骨支撑踝关节融合术治疗大骨节病性距骨坏死,愈合及融合快,可达到完全骨性愈合,并发症少,术后骨密度及生物力学功能恢复良好,疼痛缓解,临床综合效果较好,值得广泛推广应用.%Objective To study the effect of fibula support ankle arthrodesis in the treatment of Kashin-Beck disease talus necrosis (KTN).Methods A total of 45 cases with KTN treated in Department of Orthopaedics,Baoji Hospital of Traditional Chinese Medicine from January 2012 to January 2016 were selected.All patients were given fibula support ankle arthrodesis treatment.The follow-up conditons were recorded.X ray of the anklelateral was taken to observe the bone fusion,and given histological observation.Bone mineral density (BMD),the maximum compression strength and the American association of ankle surgery (AOFAS) score were compared before surgery and 6,12 months after surgery.Results All patients were followed-up after surgery,with the average time of (8.5±1.1) months.The incisions were removed the stitches in 2 weeks after surgery.X ray showed bone callus formation in 4 weeks after surgery.Pain was relieved in 5 weeks after surgery,foot shape had improvement.BMD test and the corresponding biomechanics test results showed that,the BMD and the maximum compression strength had increased,the differences were statistically significant (P ＜ 0.05).The differences in different time of AOFAS scores were statistically significant (P ＜ 0.05).Conclusion Fibula support ankle arthrodesis in the treatment of KTN has fast healing and fusion,can achieve complete osseous healing,and fewer complications,postoperative recovery of BMD and biomechanics function are good,pain has relief,comprehensive clinical effect is good.It is worthy of popularization and widely application.
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