曲峰;王显军;张建中;

• 1:首都医科大学附属北京同仁医院足踝外科中心

摘要(Abstract)：

踝关节作为主要的承重关节,其骨性关节炎的发病率并不低。踝关节骨性关节炎可表现为疼痛和功能受限,严重影响患者的生活质量。对于不同病理阶段的踝关节骨性关节炎,处理方法也不尽相同。早期的骨关节炎可以采取保守治疗,如非甾体抗炎药、理疗、支具、关节腔内注射、冲击波等。冲击波、关节腔内注射透明质酸钠、富血小板血浆等疗法已显示了短期内的良好效果,而关节腔内注射皮质类固醇则多用于类风湿和痛风患者。非手术治疗无效,关节功能受限,症状加重时,可考虑行手术治疗,首选关节镜清理、外固定架牵张、自体骨软骨移植、组织工程技术及踝上截骨等方法。对于终末期踝关节骨性关节炎,踝关节融合术及全踝关节置换术各有优缺点,临床工作中需权衡选择。

关键词(KeyWords)： 踝;骨性关节炎;治疗

Abstract:

Keywords:

基金项目(Foundation): 北京市外国专家局引进国外技术、管理人才项目——重点项目(20160118)

作者(Authors): 曲峰;王显军;张建中;

参考文献(References)：

• [1]Glazebrook M,Daniels T,Younger A,et al.Comparison of healthrelated quality of life between patients with endstage ankle and hip arthrosis[J].J Bone Joint Surg Am,2008,90(3):499-505.
• [2]张树,张建中,包贝西,等.踝关节炎的病因机制及相关研究进展[J].中华骨与关节外科杂志,2015,8(4):352-358.
• [3]Delco ML,Kennedy JG,Bonassar LJ,et al.Post-Traumatic Osteoarthritis of the Ankle:A Distinct Clinical Entity Requiring New Research Approaches[J].J Orthop Res,2017,35(3):440-453.
• [4]Nakamura Y,Uchiyama S,Kamimura M,et al.Bone alterations are associated with ankle osteoarthritis joint pain[J].Sci Rep,2016,6:18717.
• [5]Schmid T,Krause FG.Conservative treatment of asymmetric ankle osteoarthritis[J].Foot Ankle Clin,2013,18(3):437-448.
• [6]Kavanaugh A,Well AF.Benefits and risks of low-dose glucocorticoid treatment in the patient with rheumatoid arthritis[J].Rheumatology(Oxford),2014,53(10):742-1751.
• [7]中华医学会风湿病学分会.类风湿关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(4):265-270.
• [8]Leirisalo-Repo M.What is the best treatment strategy for early RA?[J].Best Pract Res Clin Rheumatol,2013,27(4):523-536.
• [9]Jensen TW,Hansen MS,Horslev-Petersen K,et al.Periarticular and generalised bone loss in patients with early rheu ma toid arthritis:influence of alendronate and intra-articular glucocorticoid treatment.Post hoc analyses from the CIMESTRA trial[J].Ann Rheum Dis,2014,73(6):1123-1129.
• [10]Cohen MM,Altman RD,Hollstrom R,et al.Safety and efficacy of intra-articular sodium hyaluronate(Hyalgan)in a randomized,double-blind study for osteoarthritis of the ankle[J].Foot Ankle Int,2008,29(7):657-663.
• [11]Mei-Dan O,Carmont MR,Laver L,et al.Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus[J].Am J Sports Med,2012,40(3):534-541.
• [12]Onyekwelu I,Goldring MB,Hidaka C.Chondrogenesis,joint formation,and articular cartilage regeneration[J].J Cell Biochem,2009,107(3):383-392.
• [13]王明波,邢更彦,李志国,等.体外冲击波对体外培养兔关节软骨细胞增殖及b FGF、CTGF表达的影响[J].实用医学杂志,2011,27(7):1160-1163.
• [14]Zhao Z,Ji H,Jing R,et al.Extracorporeal shock-wave therapy reduces progression of knee osteoarthritis in rabbitsby reducing nitric oxide level and chondrocyte apoptosis[J].Arch Orthop Trauma Surg,2012,132(11):1547-1553.
• [15]刘洪柏,侯晓东,张鸣生,等.低能量体外冲击波对实验性膝骨关节炎兔膝关节软骨的影响[J].广东医学,2013,34(22):3382-3385.
• [16]Dai SM,Shan ZZ,Nakamura H,et al.Catabolic stress induces features of chondrocyte senescence through overexpression of caveolin 1:possible involvement of caveolin 1-induced downregulation of articular chondrocytes in the pathogenesis of osteoarthritis[J].Arthritis Rheum,2006,54(3):818-831.
• [17]Moretti B,Iannone F,Notarnicola A,et al.Extracorporeal shock waves down-regulate the expression of interleukin-10 and tumor necrosis factor-alpha in osteoarthritic chondrocytes[J].BMC Musculoskelet Disord,2008,(9):16.
• [18]Lee MS.Arthroscopic ankle arthrodesis[J].Clin Podiatr Med Surg,2011,28(3):511-521.
• [19]Katz JN,Gomoll AH.Advances in arthroscopic surgery:indications and outcomes[J].Curr Opin Rheumatol,2007,19(2):106-110.
• [20]Cottino U,Collo G,Morino L.Arthroscopic ankle arthrodesis:a review[J].Curr Rev Musculoskelet Med,2012,5(2):151-155.
• [21]Berlet GC,Hyer CF,Philbin TM,et al.Does fresh osteoch ondral allograft transplantation of talar osteochondral defects improve function?[J].Clin Orthop Relat Res,2011,469(8):2356-2366.
• [22]Smyth NA,Murawski CD,Haleem AM,et al.Establishing proof of concept:platelet-rich plasma and bone marrow aspirate concentrate may improve cartilage repair following surgical treatment for osteochondral lesions of the talus[J].World JOrthop,2012,3(7):101-108.
• [23]Bilge O,Doral MN,Atesok K,et al.The effects of the synovium on chondrocyte growth:an experimental study[J].Knee Surg Sports Traumatol Arthrosc,2011,19(7):1214-1223.
• [24]Mc Gahan PJ,Pinney SJ.Current concept review:osteo-chondral lesions of the talus[J].Foot Ankle Int,2010,31(1):90-101.
• [25]Kim MK,Choi SW,Kim SR,et al.Autologous chondrocyte implantation in the knee using fibrin[J].Knee Surg Sports Traumatol Arthrosc,2010,18(4):528-534.
• [26]Lee KT,Kim JS,Young KW,et al.The use of fibrin matrixmixed gel-type autologous chondrocyte implantation in the treatment for osteochondral lesions of the talus[J].Knee Surg Sports Traumatol Arthrosc,2013,21(6):1251-1260.
• [27]Judet R,Judet T.Arthrolyse et arthroplastie sous distracteur articulaire[J].Rev Chir Orthop,1978,64(5):353-365.
• [28]van Valburg AA,van Roermund PM,Lammens J,et al.Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle?A preliminary report[J].J Bone Joint Surg Br,1995,77(5):720-725.
• [29]van Valburg AA,van Roermund PM,Marijnissen AC,et al.Joint distraction in treatment of osteoarthritis:a two year followup of the ankle[J].Osteoarthritis Cartilage,1998,7(5):474-479.
• [30]Tellisi N,Fragomen AT,Kleinman D,et al.Joint Preservation of the Osteoarthritic Ankle Using Distraction Arthroplasty[J].Foot Ankle Int,2009,30(4):318-325.
• [31]Tanaka Y,Takakura Y,Hayashi K,et al.Low tibial osteotomy for varus-type osteoarthritis of the ankle[J].J Bone Joint Surg Br,2006,88(7):909-913.
• [32]Zhao H,Liang X,Li Y,et al.The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis:a biomechanical and clinical study[J].J Orthop Surg Res,2016,11(1):127.
• [33]Teramoto T,Harada S,Takaki M,et al.The Teramoto distal tibial oblique osteotomy(DTOO):surgical technique and applicability for ankle osteoarthritis with varus deformity[J].Strategies Trauma Limb Reconstr,2018,13(1):43-49.
• [34]Schneider D.Arthroscopic ankle fusion[J].Arthroscopic Video J,1983,3:74.
• [35]Gougoulias N,Khanna A,Maffuli N.How successful are current ankle replacements?A systematic review of the literature[J].Clin Orthop Relat Res,2010,468(1):199-208.
• [36]Kerkhoff YR,Kosse NM,Metsaars WP,et al.Long-term Functional and Radiographic Outcome of a Mobile Bearing Ankle Prosthesis[J].Foot Ankle Int,2016,37(12):1292-1302.
• [37]欧乙利,刘雷.创伤性踝关节炎的治疗进展[J].现代临床医学,2016,42(3):238-240.