Lower Tibial Osteotomy for Osteoarthritis of the Ankle

在目前踝關節融合術仍為治療大部分踝關節炎的選擇，但即使如此為人所用，它仍有許多不儘令人滿意之處，如：須長期固定、關節黏合不牢，且踝關節融合後，負載會傳導至週邊關節對其產生負荷等。而下脛骨切骨矯正術，就是用於較早期之踝關節炎以期疏緩關節炎之進行而能避免關節炎末期不得已的踝關節融合術。從1989年8月起，我們做了8個下脛骨里切術以治療中期之踝關節炎。這些患者包括4例退化性關節炎和4例傷後性關節炎，年節從21歲到72歲，平均41.6歲，平均接受追蹤31.7個月。在足踝功能之評估上，從術前平均49.6分改善到最近一次追蹤評估的88.5分，且有逐年改善之趨勢。而最明顯之改善是在疼痛的疏減，至於踝關節之活動則只有一例無改善。有一例有遲發性感染，一例內固定鋼板斷裂而再次接受手術後癒合，所以全部患者骨切處均有良好之癒合。雖然我們病例不多，但短質追蹤的結果令人鼓舞：下脛骨切骨矯正術由於將關節面承受壓力再重新分佈而疏緩踝關炎，也許可使踝關節避免被黏合之命運。

關鍵字

無資料

並列摘要

Ankle arthrodesis is still the treatment of choice for most disabling arthritic ankles. But in spite of its popularity, ankle arthodesis has many disadvantages, including long immobilization, a high pseudoarthrosis rate, and load shift with increased stress on neighboring joints of ankle. Lower tibial osteotomy is one of the methods which attem-pts to halt ankle arthritis in the intermediate stage and trying to prevent ankle ar-throadesis. From Aug. 1989, we performed 8 operations of lower tibial osteotomy in our hospital on intermediate arthritic ankle which included 4 post-traumatic ankle arthritis and 4 ankle osteoarthritis. The patient’s ages ranged from 21y/o to 72y/o with an ave-rage of 41.6y/o. The mean time of followed up was 31.7 months. The patients were eva-luated by the ankle functional scale preoperatively and during their followed up. The average preoperative functional score was 49.6 and the last follow up score was 88.5 which is increasing year by year. Significant improvement occurred in function and pain relief and there was improvement of ankle motion in most patients except one. Com-plications included late infection in 1 patient and implant failure with subsequent revi-sion surgery due to overcorrection in 1 patient. No nonunion was noted. Although our series was small, we had encouraging short-term results. We believe lower tibial os-teotomy, by pressure redistribution on the joint surface, is an alternative for the treat-ment of ankle osteoarthritis and may save or delay arthritic ankle from the fate of fu-sion.

並列關鍵字

Ankle Arthritis ； Reconstructional Osteotomy

國際替代計量

Lower Tibial Osteotomy for Osteoarthritis of the Ankle

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