Myerson Mark S, Mroczek Kenneth
Union Memorial Orthopaedics, The Johnston Professional Building, #400, 3333 North Calvert Street, Baltimore, MD 21218, USA.
Foot Ankle Int. 2003 Jan;24(1):17-21. doi: 10.1177/107110070302400102.
A retrospective radiographic and chart review was performed for the initial 50 patients who underwent Agility (DePuy, Warsaw IN) total ankle arthroplasty by the senior author (M.S.M.). The review focused on the perioperative complications of nerve or tendon lacerations, intraoperative fractures, acute deep infections, wound complications and component positioning. Major wound complications were defined as those requiring a soft-tissue coverage procedure. Minor wound complications did not require soft tissue coverage and included wound breakdowns, wound edge necrosis, and superficial infections. The immediate mortise and lateral postoperative radiographs were reviewed to measure component positioning. The patients were divided into two groups to compare the initial 25 patients (Group A) with the subsequent 25 patients (Group B). There were no major wound complications in either group. Minor wound complications decreased from six in Group A to two in Group B. There were four lacerations (flexor hallucis longus, posterior tibial tendon, deep peroneal nerve, and superficial peroneal nerve), all occurring in Group A. Five patients sustained intraoperative fractures in Group A, as compared with two fractures in Group B. The number of components varying greater than 4 degrees from neutral as measured by the lateral talar, lateral tibial and mortise tibial component angles decreased by 9% from Group A to Group B. The only tibial component to be placed in more than 4 degrees of valgus occurred in Group A. It seems that a notable learning curve exists in the performance of total ankle arthroplasty as demonstrated by a comparison of the initial 25 patients with the subsequent 25 patients performed by one orthopaedic surgeon. This improvement most likely resulted from the use of enhanced techniques and further training with the prosthesis. This information can be used as a teaching tool to decrease the incidence of complications for surgeons performing their initial arthroplasties with this potentially technically demanding procedure.
资深作者（M.S.M.）对最初接受Agility（DePuy，印第安纳州华沙）全踝关节置换术的50例患者进行了回顾性影像学和病历审查。审查重点是神经或肌腱撕裂、术中骨折、急性深部感染、伤口并发症和假体位置等围手术期并发症。主要伤口并发症定义为需要软组织覆盖手术的并发症。次要伤口并发症不需要软组织覆盖，包括伤口裂开、伤口边缘坏死和浅表感染。对术后即刻的正位和侧位X线片进行审查以测量假体位置。将患者分为两组，比较最初的25例患者（A组）和随后的25例患者（B组）。两组均未出现主要伤口并发症。次要伤口并发症从A组的6例降至B组的2例。有4例撕裂（拇长屈肌、胫后肌腱、腓深神经和腓浅神经），均发生在A组。A组有5例患者发生术中骨折，而B组为2例。根据距骨外侧、胫骨外侧和踝关节正位胫骨假体角度测量，假体角度与中立位相差大于4度的数量从A组到B组减少了9%。唯一一例胫骨假体外翻超过4度的情况出现在A组。通过比较一位骨科医生最初治疗的25例患者和随后治疗的25例患者可以看出，全踝关节置换术的实施似乎存在明显的学习曲线。这种改善很可能源于技术的改进和对假体的进一步培训。这些信息可作为教学工具，以降低外科医生在进行这一潜在技术要求较高的初次关节置换术时的并发症发生率。
