踝关节融合术治疗终末期踝关节炎的研究进展

Research Progress of Ankle Arthrodesis in the Treatment of End-Stage Ankle Arthritis

摘要: 目的：综述终末期踝关节炎踝关节融合术的术式要点与固定加压策略，为临床个体化选择提供参考。方法：归纳开放融合术不同入路与关节镜下融合术的技术特点、适应证及局限性，并总结外固定、螺钉、钢板、髓内钉及联合固定等方式的应用要点。结果：开放融合术利于暴露与矫形，适合畸形明显或需处理骨缺损者，但软组织创伤较大；关节镜下融合术创伤小、软组织并发症少，适合畸形较轻及软组织条件欠佳者，但对经验与设备要求高。固定方式应结合骨质量、畸形、缺损及感染风险综合选择，必要时联合固定增强稳定性。结论：踝关节融合术可有效缓解疼痛并改善功能；应根据患者与局部条件合理选择术式及固定方案，以提高融合率并降低并发症。

Abstract: Objective: To summarize the surgical techniques and fixation/compression strategies of ankle arthrodesis for end-stage ankle arthritis, and to provide references for individualized clinical decision-making. Methods: The technical features, indications, and limitations of open ankle arthrodesis via different approaches and arthroscopic ankle arthrodesis were reviewed. Fixation and compression options, including external fixation, screw fixation, plate fixation, intramedullary nail fixation, and hybrid fixation, were also summarized. Results: Open arthrodesis offers adequate exposure and facilitates deformity correction, making it suitable for cases with obvious deformity or bone defects, but it is associated with greater soft-tissue trauma. Arthroscopic arthrodesis is minimally invasive with fewer soft-tissue complications and is more appropriate for mild deformity and compromised soft tissues; however, it requires advanced expertise and specialized equipment. The choice of fixation should be tailored according to bone quality, deformity/bone loss, and infection risk; hybrid fixation may be considered to enhance stability when necessary. Conclusion: Ankle arthrodesis effectively relieves pain and improves function in end-stage ankle arthritis. Surgical approach and fixation strategy should be individualized to improve fusion rates and reduce complications.