Laughlin T J, Payette C R
Foot and Ankle Associates, Jacksonville, Illinois, USA.
Clin Podiatr Med Surg. 1999 Jul;16(3):527-55.
The current literature clearly supports the use of subtalar and triple arthrodeses for the treatment of end-stage PTTD. There is debate, however, regarding whether or not an isolated fusion is preferable to the triple arthrodesis. Complete evaluation of the patient's deformity and symptoms is imperative before choosing to perform a rearfoot fusion. If the deformity can be isolated to the STJ, then perhaps a limited fusion is appropriate. With the close interrelationship of the subtalar and midtarsal joints, however, it is the authors' opinion that chronic dysfunction of the posterior tibial tendon infrequently causes isolated STJ pathology. Perhaps earlier intervention in the process of tendon degeneration, before multiple joint adaptations, would warrant an isolated fusion. We anticipate further research into the advantages of STJ and double arthrodeses over the triple arthrodesis. Clearer identification of the patients in whom these limited fusions are warranted is necessary, especially with respect to adult flatfoot secondary to PTTD. Currently, isolated and combined hindfoot fusions continue to be valuable salvage procedures in the treatment of end-stage arthritic deformities.
当前的文献明确支持使用距下关节融合术和三关节融合术来治疗终末期胫后肌腱功能不全（PTTD）。然而，对于单纯融合术是否优于三关节融合术仍存在争议。在选择进行后足融合术之前，对患者的畸形和症状进行全面评估至关重要。如果畸形仅限于距下关节（STJ），那么有限融合术可能是合适的。然而，鉴于距下关节和中跗关节之间密切的相互关系，作者认为胫后肌腱的慢性功能障碍很少导致孤立的距下关节病变。也许在肌腱退变过程中，在多个关节出现适应性改变之前进行早期干预，才值得采用单纯融合术。我们期待进一步研究距下关节融合术和双关节融合术相对于三关节融合术的优势。有必要更明确地确定适合这些有限融合术的患者，特别是对于继发于PTTD的成人扁平足患者。目前，孤立和联合后足融合术在治疗终末期关节炎畸形方面仍然是有价值的挽救手术。
