Bednarz P A, Monroe M T, Manoli A
Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan, USA.
Foot Ankle Int. 1999 Jun;20(6):356-63. doi: 10.1177/107110079902000603.
The intermediate outcome of patients who underwent a triple arthrodesis for the treatment of adult foot disorders was evaluated with an outcome tool to determine if their pain and functional status were improved. We evaluated 63 feet in 57 patients who underwent a triple arthrodesis using rigid internal fixation for the treatment of hindfoot deformities associated with symptomatic arthrosis. Twenty-four men and thirty-three women, with an average age of 54 years, were evaluated. The average follow-up was 30 months. Multiple diagnoses contributed to hindfoot deformities with secondary arthrosis. Iliac crest bone graft was used in 56 of 63 cases (89%). Percutaneous heel cord lengthening was done in 53 of 63 cases (84%). Twenty-four of the thirty patients (80%) returned to work. Twenty-five patients were retired and two were unemployed before surgery. All patients except two (97%) were satisfied with the surgery and would have the surgery again. The average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot preoperative score was 28 points, and the average postoperative score was 81 points (P < 0.0001). In the radiographic measurements, there was an average improvement of 12 degrees in the lateral talometatarsal angle, 7 degrees in the lateral talocalcaneal angle, and 10 degrees in the AP talometatarsal angle (P < 0.0001). Complications experienced included two varus malunions, two valgus malunions, two nonunions, two deep vein thromboses, one distal fibula stress fracture, and one wound infection. Of the 26 feet in 22 patients with mortise views available, 10 feet (38%) had evidence of ankle arthrosis and 19 feet (73%) had some degree of talar tilt postoperatively.
采用一种结果评估工具对接受三关节融合术治疗成人足部疾病患者的中期结果进行评估，以确定其疼痛和功能状态是否得到改善。我们评估了57例接受三关节融合术并采用坚强内固定治疗与症状性关节病相关的后足畸形患者的63只足。评估对象包括24名男性和33名女性，平均年龄54岁。平均随访时间为30个月。多种诊断导致后足畸形继发关节病。63例中有56例（89%）使用了髂嵴骨移植。63例中有53例（84%）进行了经皮跟腱延长术。30例患者中有24例（80%）恢复工作。25例患者术前已退休，2例失业。除2例患者外，所有患者（97%）对手术满意，愿意再次接受手术。美国矫形足踝协会踝关节-后足术前平均评分为28分，术后平均评分为81分（P < 0.0001）。在影像学测量中，外侧距舟角平均改善12度，外侧距跟角平均改善7度，前后位距舟角平均改善10度（P < 0.0001）。出现的并发症包括2例内翻畸形愈合、2例外翻畸形愈合、2例骨不连、2例深静脉血栓形成、1例腓骨远端应力性骨折和1例伤口感染。在22例有榫眼位片的患者的26只足中，10只足（38%）有踝关节病证据，19只足（73%）术后有一定程度的距骨倾斜。
