中文摘要：

目的探讨对踝关节重度骨关节炎采用关节镜下踝关节融合术的近期疗效和手术要点。方法 2007年7月至2012年12月,本科采用关节镜直视下的踝关节融合术共治疗25例重度踝关节骨关节炎,这些患者在门诊保守治疗后仍疼痛明显。术前行踝关节正侧位摄片和磁共振检查,术中建立踝关节镜通道,首先彻底清除残留关节面软骨,然后行关节端＂微骨折＂处理,初步复位踝关节于功能位,克氏针临时固定,＂C＂臂机透视确认后,旋入空心螺钉。术后石膏托固定6周,然后在保护下部分负重锻炼直至骨性愈合。记录术前和术后1年的疼痛评分,并进行统计学分析。结果所有患者获得随访,均在术后10～16（12±1）周骨性融合,疼痛缓解,步态改善;有1例同期实施小切口辅助下的距下关节融合术。未出现切口愈合不良和感染的早期并发症,随访1～5年,有2例单纯踝关节融合术后患者出现距下关节炎伴轻度疼痛,经保守治疗后症状缓解未进一步手术。根据疼痛评分,术前评分（7.9±1.4）分,术后1年评分（2.1±0.8）分,差异有统计学意义（P=0.005）。结论对保守治疗无效的重度踝关节骨关节炎患者,采用关节镜下的踝关节融合术,具有创伤小、切口美观、融合率高等优势,但同时存在设备要求和学习曲线的前提条件。

英文摘要：

Objective To introduce a minimal surgical treatment for severe ankle primary arthritis under arthroscope and its corresponding clinical outcome. Methods From July 2007 to December 2012,a total of 25 patients with ankle primary arthritis after failed conservative treatment were treated by arthroscopic arthrodesis in our hospital. Weight-bearing anteroposterior（ AP） radiography and MR imaging were performed preoperatively to identify the degree of varus / valgus deformity. Firstly,the portal was established during the surgery,and the remaining articular cartilage was removed with a combination of a debrider and curettes under direct vision. Then the foot was positioned correctly in neutral flexion with 2 cannulated percutaneous screws.The patient was mobilised non-weight bearing for 6 weeks,followed by partial weight-bearing until radiological union. Visual analogue scale（ VAS） was used to evaluate the pain before and in 1 year after surgery,and the results were analyzed statistically. Results All ankle arthrodesis were union in a mean duration of 12 ± 1weeks（ ranging from 10 to 16）. They got pain relief and improvement in gait. One case underwent subtalar joint fusion with aid of a small incision during the arthroscopic surgery. No severe complication,such as poor wound healing or infection was found in the cohort. Two patients had complained mild pain after ankle arthrodesis and then satisfied with reservation treatment. VAS system showed all patients got pain relief after ankle arthrodesis（ before 7. 9 ± 1. 4 vs 1 year after 2. 1 ± 0. 8,P = 0. 005）. Conclusion For the patients suffering from severe ankle primary arthritis,if conservation treatment is not effective,arthroscopic ankle arthrodesis is a good approach with small trauma,sound wound appearance,and high union rate. Technique and instrument are critical for success.