Kennedy John G, Harty James A, Casey Kevin, Jan Waqar, Quinlan William B
Department of Orthopaedics, Hospital for Special Surgery, New York, NY 10021, USA.
Clin Orthop Relat Res. 2003 Jul(412):131-8. doi: 10.1097/01.blo.0000071755.41516.a0.
The established treatment for severe rheumatoid arthritis in the ankle is arthrodesis. Numerous reports in the literature describe outcomes in patients with degenerative and posttraumatic arthrosis and rheumatoid disease. This has led to results that are difficult to interpret. In addition, in the few studies that have evaluated patients with rheumatoid disease many techniques of arthrodesis are reported, further confounding assessment of one fusion method. One technique of 20 ankle fusions in patients with rheumatoid disease was evaluated. A modified Wagner arthrodesis was used through a transfibular approach using parallel compression screws. The scoring systems of Mazur et al, Moran et al, and the Short-Form-36 were used to evaluate the outcome. The mean time to followup was 3 years 10 months. Eighteen of 20 fusions obtained a solid talocrural union (90%). No correlation was found between the scores of Mazur et al and Moran et al. Correlation was achieved between the scores for the Short Form-36 and Moran et al. The modified Wagner ankle arthrodesis is a simple, reliable, reproducible technique with a 90% union rate. The value of the technique has been confirmed in patients with rheumatoid arthritis by evaluating the outcome using a scoring system that is validated and relevant to this population.
踝关节重度类风湿性关节炎的既定治疗方法是关节融合术。文献中有大量报告描述了退行性和创伤后关节病以及类风湿病患者的治疗结果。这导致结果难以解读。此外，在少数评估类风湿病患者的研究中，报告了多种关节融合技术，这进一步混淆了对一种融合方法的评估。对类风湿病患者的20例踝关节融合术的一种技术进行了评估。采用改良的瓦格纳关节融合术，通过经腓骨入路使用平行加压螺钉。使用马祖尔等人、莫兰等人的评分系统以及简短健康调查问卷36项（Short-Form-36）来评估结果。平均随访时间为3年10个月。20例融合术中18例实现了牢固的距小腿关节融合（90%）。未发现马祖尔等人和莫兰等人的评分之间存在相关性。简短健康调查问卷36项的评分与莫兰等人的评分之间存在相关性。改良的瓦格纳踝关节融合术是一种简单、可靠、可重复的技术，融合率为90%。通过使用经过验证且与该人群相关的评分系统评估结果，该技术在类风湿性关节炎患者中的价值得到了证实。
