一期融合治疗踝及后足感染性关节炎

Single-stage arthrodesis for septic arthritis of the ankle and hindfoot

摘要

目的：评估一期清创、关节融合、Ilizarov 外固定架固定治疗踝及后足感染性关节炎的临床效果。方法：选择2015年4月至2023年6月北京积水潭医院足踝外科由同一术者行一期清创、关节融合、Ilizarov 外固定架固定手术治疗的 12 例踝关节及后足感染性关节炎患者的临床资料进行回顾性分析，其中男 8 例，女 4 例；手术时平均年龄为（53.6±16.2）岁，均为单侧手术。记录患者一般临床特征、细菌培养结果和拆除外固定架时间，记录并比较患者术前及末次随访时美国足踝外科协会（American Orthopaedic Foot and Ankle Society，AOFAS）踝-后足评分和疼痛视觉模拟评分（visual analogue scale，VAS），记录患者对手术的满意度以及并发症发生情况。结果：所有患者术后平均随访（51.3±34.0）个月，其中细菌培养阳性 7 例。所有患者感染均得到控制，骨愈合率 100% ，中位外固定架拆除时间 16 （12,24）周。术前，中位 VAS 评分 7 (5.3,7.8)  分，平均 AOFAS 踝-后足评分（42.8±10.4）分；末次随访时，中位 VAS 评分 1(0,2) 分，平均 AOFAS 踝-后足评分（77.6±10.2）分，均较术前显著改善（P<0.01）。并发症方面，针道感染 1 例，肢体短缩 3 例，肢体麻木 2 例。 12 例患者 9 例对手术非常满意， 3 例对手术满意。结论：一期清创、关节融合、Ilizarov 外固定架固定是治疗踝及后足感染性关节炎的可靠方法，能有效控制感染，缩短治疗时间，且患者术后功能恢复及影像学结果良好。

Abstract

Objective：To evaluate the clinical outcomes of one-stage debridement，arthrodesis，and Ilizarov external fixation for the treatment of septic arthritis of the ankle and hindfoot. Methods：A retro- spective analysis was conducted on 12 patients with septic arthritis of the ankle or hindfoot who underwent one-stage debridement，arthrodesis，and Ilizarov external fixation performed by the same surgeon between April 2015 and June 2023.The study included 8 males and 4 females，with a mean age of（53.6 ± 16.2）years at surgery；all procedures were unilateral.General clinical characteristics，bacterial culture results，and the time to external fixator removal were recorded.The American Orthopaedic Foot and An-kle Society（AOFAS）ankle-hindfoot score and the visual analogue scale（VAS）for pain were recorded and compared between the preoperative period and the final follow-up.Patient satisfaction with the sur- gery and the occurrence of complications were also documented. Results：All patients were followed up for a mean of（51.3±34.0）months postoperatively.Positive bacterial cultures were found in 7 cases. Infection control was achieved in all patients，with a 100% bone fusion rate confirmed by radiographs or CT.The median time to external fixator removal was 16(12,24) weeks.Preoperatively，the median VAS score was 7 （5.3，7.8）points，and the mean AOFAS ankle-hindfoot score was（42.8 ± 10.4） points.At the final follow-up，the median VAS score was 1(0,2) point，and the mean AOFAS score was（77.6 ± 10.2）points，both showing significant improvement compared with preoperative values（P< 0.01).Regarding complications，there was 1 case of pin tract infection， 3 cases of limb shortening，and 2 cases of skin numbness.Nine patients were very satisfied with the surgery，and 3 were satisfied. Conclusion：One-stage debridement，arthrodesis，and Ilizarov external fixation are a reliable method for treating septic arthritis of the ankle and hindfoot.It effectively controls infection，shortens treatment dura- tion，and yields favorable functional and imaging outcomes，with high patient satisfaction and acceptable complication rates.

关键词

感染性关节炎 / 踝关节 / 后足 / 一期手术 / 融合

Key words

Septic arthritis / Ankle / Hindfoot / Single-stage procedure / Arthrodesis

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基金资助

北京市卫生健康科技成果和适宜技术推广项目(BHTPP2024038)