[1]陈红浩,张春雷,窦浚峰,等.踝关节牵开成形术在距骨病变早期治疗中的应用价值[J].中医正骨,2019,31(10):66-69.
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踝关节牵开成形术在距骨病变早期治疗中的应用价值()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年10期
页码:
66-69
栏目:
外固定技术
出版日期:
2019-10-20

文章信息/Info

作者:
陈红浩张春雷窦浚峰马海龙张景义杨昊飞严磊海国栋
(郑州市骨科医院,河南 郑州 450052)
关键词:
距骨 踝关节 牵开成形术 骨折 骨囊肿 骨坏死 骨关节炎
摘要:
目的:探讨踝关节牵开成形术在距骨病变早期治疗中的应用价值。方法:2000年10月至2016年6月收治18例距骨病变患者。男14例,女4例。年龄27~66岁,中位数53岁。左侧11例,右侧6例,双侧1例。距骨骨折10例,距骨骨囊肿5例,距骨缺血性坏死2例,距骨骨关节炎1例。距骨骨折患者行闭合复位外固定术或切开复位内固定术,距骨骨囊肿患者行囊变刮除植骨术,距骨缺血性坏死患者行钻孔减压术,距骨骨关节炎患者行微骨折术,同时所有患者均采用llizarov外固定架行踝关节牵开成形术。术后1周开始牵开踝关节,每天2次,每次0.5 mm。5 d后拍摄踝关节正侧位X线片,确认踝关节牵开间隙达到5 mm左右,且踝关节无明显畸形,活动踝关节无明显撞击、疼痛现象后,锁定外固定架,开始逐渐负重锻炼。结果:开始负重锻炼时间为术后12~15 d,中位数14 d。所有患者均获得随访,随访时间36~65个月,中位数44个月。外固定架带架时间4~6个月,中位数5个月。所有距骨病变均得到有效治疗,患肢均可全足负重,恢复正常行走步态。10例距骨骨折患者骨折均愈合。5例距骨骨囊肿患者,术后6个月植骨均愈合,表面纤维软骨形成良好。美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)足踝功能评分,术前为(54.1±12.7)分、术后6个月为(84.3±7.6)分、术后12个月为(85.7±10.6)分。5例发生针道感染,经换药和应用抗生素治疗后治愈。1例患者小腿局部皮肤出现过敏性湿疹,给予抗过敏药物治疗后症状消失。结论:在距骨病变早期治疗中应用踝关节牵开成形术,能为距骨病变提供一个良好的修复环境,允许患者早期负重锻炼,有助于踝关节功能恢复及避免长期不负重导致的各种并发症,安全性较高。

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备注/Memo

备注/Memo:
通讯作者:海国栋 E-mail:haiwenhappy@126.com(收稿日期:2019-08-04 本文编辑:李晓乐)
更新日期/Last Update: 2019-10-15