Thordarson David B
Foot and Ankle Trauma and Reconstructive Surgery, University of Southern California, 1200 North State Street, Los Angeles, CA 90033, USA.
J Am Acad Orthop Surg. 2004 Sep-Oct;12(5):322-33. doi: 10.5435/00124635-200409000-00007.
Despite appropriate acute treatment, many foot and ankle injuries result in posttraumatic arthritis. Arthrodesis remains the mainstay of treatment of end-stage arthritis of the foot and ankle. An understanding of the biomechanics of the foot and ankle, particularly which joints are most responsible for optimal function of the foot, can help guide reconstructive efforts. A careful history and physical examination, appropriate radiographs, and, when necessary, differential selective anesthetic blocks help limit fusion to only those joints that are causing pain. Compression fixation, when possible, remains the treatment of choice. When bone defects are present, however, neutralization fixation may be necessary to prevent a secondary deformity that could result from impaction into a bone defect.
尽管进行了适当的急性治疗，但许多足踝部损伤仍会导致创伤后关节炎。关节融合术仍然是足踝部终末期关节炎的主要治疗方法。了解足踝部的生物力学，特别是哪些关节对足部的最佳功能最为关键，有助于指导重建工作。详细的病史和体格检查、合适的X光片，以及必要时进行的选择性局部麻醉阻滞，有助于将融合手术仅局限于那些引起疼痛的关节。尽可能采用加压固定仍是首选治疗方法。然而，当存在骨缺损时，可能需要采用中和固定以防止因嵌入骨缺损而导致的继发性畸形。
