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[1]陳紅浩,張春雷,竇浚峰,等.踝關節(jié)牽開成形術在距骨病變早期治療中的應用價值[J].中醫(yī)正骨,2019,31(10):66-69.
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踝關節(jié)牽開成形術在距骨病變早期治療中的應用價值()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年10期
頁碼:
66-69
欄目:
外固定技術
出版日期:
2019-10-20

文章信息/Info

作者:
陳紅浩張春雷竇浚峰馬海龍張景義楊昊飛嚴磊海國棟
(鄭州市骨科醫(yī)院,河南 鄭州 450052)
關鍵詞:
距骨 踝關節(jié) 牽開成形術 骨折 骨囊腫 骨壞死 骨關節(jié)炎
摘要:
目的:探討踝關節(jié)牽開成形術在距骨病變早期治療中的應用價值。方法:2000年10月至2016年6月收治18例距骨病變患者。男14例,女4例。年齡27~66歲,中位數(shù)53歲。左側11例,右側6例,雙側1例。距骨骨折10例,距骨骨囊腫5例,距骨缺血性壞死2例,距骨骨關節(jié)炎1例。距骨骨折患者行閉合復位外固定術或切開復位內(nèi)固定術,距骨骨囊腫患者行囊變刮除植骨術,距骨缺血性壞死患者行鉆孔減壓術,距骨骨關節(jié)炎患者行微骨折術,同時所有患者均采用llizarov外固定架行踝關節(jié)牽開成形術。術后1周開始牽開踝關節(jié),每天2次,每次0.5 mm。5 d后拍攝踝關節(jié)正側位X線片,確認踝關節(jié)牽開間隙達到5 mm左右,且踝關節(jié)無明顯畸形,活動踝關節(jié)無明顯撞擊、疼痛現(xiàn)象后,鎖定外固定架,開始逐漸負重鍛煉。結果:開始負重鍛煉時間為術后12~15 d,中位數(shù)14 d。所有患者均獲得隨訪,隨訪時間36~65個月,中位數(shù)44個月。外固定架帶架時間4~6個月,中位數(shù)5個月。所有距骨病變均得到有效治療,患肢均可全足負重,恢復正常行走步態(tài)。10例距骨骨折患者骨折均愈合。5例距骨骨囊腫患者,術后6個月植骨均愈合,表面纖維軟骨形成良好。美國足踝外科協(xié)會(American Orthopaedic Foot and Ankle Society,AOFAS)足踝功能評分,術前為(54.1±12.7)分、術后6個月為(84.3±7.6)分、術后12個月為(85.7±10.6)分。5例發(fā)生針道感染,經(jīng)換藥和應用抗生素治療后治愈。1例患者小腿局部皮膚出現(xiàn)過敏性濕疹,給予抗過敏藥物治療后癥狀消失。結論:在距骨病變早期治療中應用踝關節(jié)牽開成形術,能為距骨病變提供一個良好的修復環(huán)境,允許患者早期負重鍛煉,有助于踝關節(jié)功能恢復及避免長期不負重導致的各種并發(fā)癥,安全性較高。

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備注/Memo

備注/Memo:
通訊作者:海國棟 E-mail:[email protected](收稿日期:2019-08-04 本文編輯:李曉樂)
更新日期/Last Update: 2019-10-15