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踝关节牵开成形联合富血小板血浆注射治疗创伤性踝关节炎

Ankle distraction arthroplasty with platelet-rich plasma injection for post-traumatic ankle arthritis
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摘要 目的观察踝关节牵开成形联合富血小板血浆(PRP)注射治疗创伤性踝关节炎的疗效。方法回顾性分析自2012年5月至2017年5月上海健康医学院附属第六人民医院东院骨科和上海交通大学附属第六人民医院骨科共治疗的32例创伤性踝关节炎患者资料,其中男22例,女10例;年龄(32.6±5.8)岁(18~40岁)。患者病程(14.0±2.8)个月(6~24个月),经至少6个月保守治疗无效后行踝关节牵开成形联合关节腔内注射PRP。术后采用美国足踝外科协会(AOFAS)踝-后足评分、疼痛视觉模拟评分(VAS)评估治疗效果,并记录踝关节活动度及相关并发症。结果术后12例患者出现针道感染,经针道护理后愈合。本组患者获平均36个月(18~60个月)随访。患者VAS评分从术前(6.8±1.2)分降至末次随访时(1.8±1.4)分,AOFAS踝-后足评分从术前(38.5±6.2)分提高至末次随访时(80.3±8.1)分,踝关节背伸活动度从术前8.3°±7.0°提高至末次随访时12.8°±6.5°,跖屈活动度从术前24.7°±6.4°提高至末次随访时31.4°±5.3°,以上比较差异均有统计学意义(P< 0.05)。2例患者因症状及影像学关节炎表现进行性加重,保守治疗无效后最终行踝关节融合治愈。结论采用踝关节牵开成形术联合PRP注射治疗踝关节创伤性关节炎可有效缓解症状,改善功能,延缓病程进展,是有效的保踝治疗技术。 Objective To evaluate the surgical techniques and clinical outcomes of ankle distraction arthroplasty with platelet-rich plasma (PRP) injection for post-traumatic ankle arthritis. Methods From May 2012 to May 2017, 32 patients with post-traumatic ankle arthritis were treated at Department of Or-thopaedic Surgery, Shanghai Sixth People’s Hospital.They were 22 males and 10 females, with an age of 32.6±5.8 years (from 18 to 40 years).Their course of disease was 14.0±2.8 months (from 6 to 24 months).After failure of the conservative management for at least 6 months, they received ankle distraction arthroplasty with PRP injection.American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the final overall outcomes.Range of motion (ROM) of the ankle joint and complications were also recorded postoperatively. Results Pin tract infection occurred in 12 patients but responded to alcohol care.All the patients were followed up for an average of 36 months (from 18 to 60 months).The VAS score decreased significantly from preoperative 6.8±1.2 to postoperative 1.8±1.4;the AOFAS ankle-hindfoot score increased significantly from preoperative 38.5±6.2 to 80.3±8.1 at the final follow-up;dorsal expansion and plantar flexion of the ankle increased significantly from pre-operative 8.3°±7.0° and 24.7°±6.4° to 12.8°±6.5° and 31.4°±5.3° at the final follow-up, respectively(all P<0.05).Two patients had to receive salvage arthrodesis after conservative management failed to re-lieve their symptoms or delay the progression of their post-traumatic arthritis. Conclusion Ankle dis-traction arthroplasty with PRP injection is an effective ankle preserving surgery which can relieve symptoms, improve functions and delay progression of post-traumatic ankle arthritis.
作者 顾文奇 徐宏威 王晓康 蒋剑涛 李振东 陈城 邹剑 薛剑锋 苏琰 梅国华 施忠民 Gu Wenqi;Xu Hongwei;Wang Xiaokang;Jiang Jiantao;Li Zhendong;Chen Cheng;Zou Jian;Xue Jianfeng;Su Yan;Mei Guohua;Shi Zhongmin(Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital East Campus, Shanghai 201306, China;Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai 200233, China)
出处 《中华创伤骨科杂志》 CAS CSCD 北大核心 2019年第4期321-327,共7页 Chinese Journal of Orthopaedic Trauma
关键词 踝关节 关节炎 关节成形术 富血小板血浆 Ankle joint Arthritis Arthroplasty Platelet-rich plasma
作者简介 第一作者:顾文奇;第一作者:徐宏威;通信作者:施忠民,Email:18930177323@163.com。
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