关节端微骨折处理配合关节镜提高踝关节融合术长期效果的评价及其对围手术期氧化应激和并发症的影响

Evaluation of joint end microfracture treatment combined with arthroscopy to improve the long-term effect of ankle joint fusion and influence on oxidative stress and complications during perioperative period

摘要:

目的 探讨关节端微骨折处理配合关节镜提高踝关节融合术长期效果的作用，及其对围手术期氧化应激和并发症的影响。方法 选取2021年2月－2023年4月该院收治的伴≤20°的内外翻畸形终末期踝关节炎患者108例，采用关节镜踝关节融合术的54例患者为关节镜组，采用关节端微骨折处理配合关节镜踝关节融合术的54例患者为改良组。比较两组患者手术指标、围手术期氧化指标［术前、术后1 d和术后3 d的丙二醛（MDA）、总氧化态（TOS）和氧化应激指数（OSI）］和抗氧化指标［术前、术后1 d和术后3 d的谷胱甘肽过氧化物酶（GSH-Px）、超氧化物歧化酶（SOD）和总抗氧化能力（TAC）］，比较术前、术后6个月和术后1年的视觉模拟评分法（VAS）评分和美国足踝外科医师学会（AOFAS）评分，比较优良率、并发症，以及内外翻不同角度患者的融合时间和术后1年AOFAS评分。结果 改良组术中出血量少于关节镜组，术后住院时间短于关节镜组，差异均有统计学意义（P < 0.05）；改良组术后1和3 d的MDA、TOS和OSI明显低于关节镜组，差异均有统计学意义（P < 0.05）；改良组术后1和3 d的GSH-Px、SOD和TAC明显高于关节镜组，差异均有统计学意义（P < 0.05）；两组患者术后6个月和1年的VAS评分和AOFAS评分比较，差异均无统计学意义（P > 0.05）；两组患者优良率比较，差异无统计学意义（P > 0.05）；改良组并发症总发生率明显低于关节镜组，差异有统计学意义（P < 0.05）；内外翻角度10°～20°的患者术后1年AOFAS评分与内外翻角度 < 10°的患者比较，差异无统计学意义（P > 0.05）；内外翻角度10°～20°的患者融合时间明显长于内外翻角度 < 10°的患者，差异有统计学意义（P < 0.05）。结论 关节端微骨折处理配合关节镜踝关节融合术治疗伴≤20°的内外翻畸形终末期踝关节炎，可避免植骨和截骨，疗效满意，且在减少术中出血、减少并发症、减轻围手术期氧化应激反应和加快术后恢复方面具有优势，但内外翻畸形明显时，会延长骨性融合时间。

Abstract:

Objective To investigate the effect of joint end microfracture treatment combined with arthroscopy on the long-term effect of ankle joint fusion and the effects on perioperative oxidative stress and complications.Methods 108 patients with end-stage ankle arthritis with internal and external inversion angles with ≤20° matching baseline data from February 2021 to April 2023 were selected. Among them, 54 patients underwent arthroscopic ankle fusion as arthroscopic group, 54 patients were treated with joint end microfracture combined with arthroscopic ankle joint fusion as improved group. The surgical indexes, perioperative oxidation indexes [malondialdehyde (MDA), total oxidation state (TOS), oxidative stress index (OSI) before surgery, 1 d after surgery and 3 d after surgery] and antioxidant indexes [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), total antioxidant capacity (TAC) before surgery, 1 d after surgery and 3 d after surgery] of the two groups were compared. Visual analogue scale (VAS score), American Orthopaedic Foot and Ankle Society (AOFAS score), before surgery, 6 months after surgery and 1 year after surgery, excellent and good rate and complications were compared between the two groups, and fusion time and AOFAS score at 1 year after surgery of patients with different internal and external inversion angles were compared between the two groups.Results The intraoperative blood loss in the improved group was less than that in the arthroscopic group, postoperative hospital stay in the improved group was shorter than that in the arthroscopic group, the differences were statistically significant (P < 0.05). The MDA, TOS and OSI levels in the improved group were lower than those in the arthroscopic group on day 1 and day 3 after operation, the differences were statistically significant (P < 0.05). The GSH-Px, SOD and TAC levels in the improved group were significantly higher than those in the arthroscopic group at 1 and 3 days after surgery, the differences were statistically significant (P < 0.05). The VAS score and AOFAS score at 6 months and 1 year after surgery in the improved group were not significantly different from those in the arthroscopic group (P > 0.05). Comparison of the excellent rate of patients in the two groups, the difference was not statistically significant (P > 0.05). The total complication rate of the improved group was significantly lower than that of the arthroscopic group, the difference was statistically significant (P < 0.05). There was no significant difference in AOFAS scores between patients with 10° ~ 20° and patients with < 10° at 1 year after surgery (P > 0.05). The fusion time of patients with internal and external inversion angles 10° ~ 20° was longer than that of patients with < 10° (P < 0.05).Conclusion Joint end microfracture treatment combined with arthroscopy ankle fusion for end-stage ankle arthritis with ≤20° internal and external varus can avoid bone grafting and osteotomy with satisfactory efficacy, and has advantages in reducing intraoperative bleeding and complications, alleviating perioperative oxidative stress, and accelerating postoperative recovery. However, when internal and external varus malformations are obvious, the time of osseous fusion can be prolonged.