Eingartner Christoph, Weise Kuno
Berufsgenossenschaftliche Unfallklinik, Eberhard-Karls-Universität Tübingen, Schnarrenbergstrasse 95, D-72076 Tübingen, Germany.
Oper Orthop Traumatol. 2005 Oct;17(4-5):481-501. doi: 10.1007/s00064-005-1140-z.
Ankle arthrodesis with the foot at 90 degrees with minimal as possible leg shortening. Regain of a pain-free use of the limb.
Failure of arthrodesis, septic or aseptic in origin, accompanied by pain interfering with weight bearing.
General surgical or anesthesiologic risks. Acute reflex sympathetic dystrophy. Significant arterial circulatory disturbances or extensive neurologic deficits. Extensive bone or soft-tissue defects after previous surgeries.
Approach using existing scars. Resection of nonunion making allowance for the planned position of arthrodesis. Removal of all necrotic bony and soft tissue. Posterior translation of talus by 1 cm. Autogenous bone grafting of major defects. Temporary fixation with a Kirschner wire with the foot at 90 degrees in the sagittal plane, in 0 degrees in the frontal plane, and 10-20 degrees of external rotation. Application of an external fixator, removal of Kirschner wire and compression of resection surfaces. If needed, apposition of cancellous bone harvested from iliac crest. Suction drain. Wound closure.
Revision of arthrodesis in 13 men and three women (average age 48 years [27-76 years]). Average follow-up 10.8 months (3-26 months). In spite of problematic preoperative conditions (local infection eight times, malposition five times) a bony consolidation occurred in 15 of 16 patients, 14 times in a perfect position. Average leg shortening 2.8 cm (1-8.5 cm). Satisfactory soft-tissue healing in twelve patients. Superficial ulceration in two patients, fistula in one. Successful repeat revision of arthrodesis in one patient on account of persisting nonunion and infection.
踝关节融合术，足部呈90度，尽可能减少腿部缩短。恢复肢体无痛使用功能。
融合术失败，原因是感染性或无菌性，伴有疼痛影响负重。
一般手术或麻醉风险。急性反射性交感神经营养不良。严重动脉循环障碍或广泛神经功能缺损。既往手术后存在广泛骨或软组织缺损。
利用现有瘢痕入路。切除骨不连，同时考虑融合术的计划位置。清除所有坏死的骨和软组织。距骨向后平移1厘米。对大的缺损进行自体骨移植。用克氏针临时固定，足部在矢状面呈90度，在额状面呈0度，外旋10 - 20度。应用外固定器，取出克氏针并对切除面进行加压。如有需要，植入取自髂嵴的松质骨。放置引流管。缝合伤口。
13名男性和3名女性（平均年龄48岁[27 - 76岁]）接受了融合术翻修。平均随访10.8个月（3 - 26个月）。尽管术前情况不佳（局部感染8次，位置异常5次），16例患者中有15例实现了骨愈合，其中14例位置理想。平均腿部缩短2.8厘米（1 - 8.5厘米）。12例患者软组织愈合良好。2例患者出现浅表溃疡，1例出现瘘管。1例患者因持续骨不连和感染成功进行了再次融合术翻修。
