作　　者： (李晔）; (高鹏）; (翁习生）; (张保中）; (林进）; (钱文伟）;

机构地区： 中国医学科学院、北京协和医学院、北京协和医院骨科,北京100730

出　　处： 《中国骨与关节外科》 2017年第2期140-143,共4页

摘　　要： 背景:踝关节是血友病性关节炎的常见受累部位,此类患者往往较早出现终末期表现而接受手术治疗。目的:探讨应用带锁髓内钉行胫距跟融合术治疗终末期血友病性踝关节炎的围手术期处理方法、术式选择及疗效。方法:2012年1月至2015年12月,我院收治终末期血友病性踝关节炎患者10例(12足),均为男性;年龄21~48岁,平均32.7岁;其中甲型血友病7例,乙型血友病3例。术前根据美国矫形足踝协会(AOFAS)评分为29~53分,平均46.2分。入院后由血液科会诊通过凝血因子预实验确定围手术期替代方案,应用带锁髓内钉行胫距跟融合术(12足)。结果:手术用时65~88 min,平均72 min;术中出血平均30 ml。所有患者均获得随访6~36个月,中位随访时间为24.3个月。所有患者末次随访时X线片检查示踝关节完全融合。末次随访时AOFAS评分为78~89分,平均83.5分。1例患者术后复查发现双侧假体周围骨折,术后半年随访骨折愈合良好,其余患者均未发生伤口愈合不良、内固定感染、神经损伤等并发症。结论:在制定良好的围手术期凝血因子替代方案后,应用带锁髓内钉行胫距跟融合术治疗终末期血友病性踝关节炎可以获得满意的临床效果。 Background：The ankle is a common involved site of hemophilia arthritis. Early end-stage manifestations of arthritis often present in those patients and surgical treatment is usually an essential method for the disease. Objective：To explore perioperative management, operation style and clinical outcome of tibiotalocalcaneal arthrodesis using interlocking intramedullary nail for end-stage haemophilic arthropathy of the ankle. Methods：Between January 2012 and December 2015, 10 male patients with end-stage haemophilic arthropathy of the ankle （12 feet） were admitted to our hospital. Their average age was 32.7 years old （range, 21-48 years old）. Among them, there were 7 cases of hemophilia A and 3 cases of hemophilia B. The mean preoperative American Orthopaedic Foot and Ankle Society （AOFAS） score was 46.2 （range, 29-53）. The alternative scheme of blood coagulation factor in the perioperative period was confirmed by the consultation of hematologists. The tibiotalocalcaneal arthrodesis was applied in all the patients by using interlocking intramedullary nail. Results： The mean operation time was 72 min （range, 65-88 min）. The median follow-up period was 24.3 months （range, 6-36 months）. X-ray examination showed the complete fusion of ankle joint achieved in all patients at the final follow-up, and the AOFAS score was 83.5 （range, 78-89）. Postoperative bilateral fracture around the prosthesis had been detected in 1 patient. After 6-month follow-up, fracture healing was good. No other complications, such as poor healing, infection or nerve injury occurred. Conclusions：After planning a good alternative scheme of the blood coagulation factor in perioperative period, tibiotalocalcaneal arthrodesis using interlocking intramedullary nail can get satisfactory clinical results for the end-stage haemophilic arthropathy of the ankle.

关 键 词： 踝关节 关节融合术 血友病 血友病 关节炎 围手术期医护