[Effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions].

Objective: To investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions. 方法: 2012 年 1 月—2016 年 12 月，对 36 例（36 足）踝关节疾病患者采用联合前踝正中纵切口及外踝跗骨窦小切口下 2 枚全螺纹无头加压螺钉加压固定行胫-距-跟融合术治疗。男 14 例，女 22 例；年龄 18～76 岁，平均 53.8 岁。左足 19 例，右足 17 例。距骨塌陷性坏死 21 例，创伤性关节炎 7 例，类风湿性关节炎 3 例，结核感染（非活动性）2 例，距骨缺如 1 例， Charcot 关节病 1 例，踝及距下关节绒毛结节性滑膜炎 1 例。术前美国矫形足踝协会（AOFAS）评分为（53.7±2.5）分，疼痛视觉模拟评分（VAS）为（5.9±0.2）分。记录手术时间、术后患者切口愈合以及并发症发生情况，X 线片及 CT 检查关节面是否达骨性融合，AOFAS 评分和 VAS 评分评价关节功能及疼痛情况。 Results: The mean operation time was 49.8 minutes (range, 33-82 minutes). Incision infection occurred in 1 patient (2.8%) at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of 18.5 months (range, 12-29 months). Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks (range, 8-15 weeks). After 1 year, the AOFAS score (84.7±0.6) and VAS score (0.3±0.1) were significantly higher than preoperative scores ( t=12.596, P=0.000; t=30.393, P=0.000). Conclusion: It is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle disease because of the less complications incidence and the higher postoperative fusion rate.