Zwipp Hans, Grass René
Direktor der Unfallchirurgischen Universitätsklinik Carl Gustav Carus, Fetscherstrasse 74, D-01307 Dresden, Germany.
Oper Orthop Traumatol. 2005 Oct;17(4-5):518-33. doi: 10.1007/s00064-005-1143-9.
Report of four patients.
Restoration of a painless gait through ankle arthrodesis after failed total ankle replacement.
Loosened or infected total ankle replacement.
Poor general health. Absent patient compliance.
Removal of total joint components. Filling of the defect with tricortical bone grafts harvested from the ipsilateral iliac crest and internal fixation. In instances of suspected infection a two-stage procedure is recommended, the first stage consisting of a removal of the components, a meticulous debridement, and filling of the defect with gentamycin-laden PMMA beads. Second stage: arthrodesis.
The goal of surgery was reached without complications in two out of four patients. An absence of bony bridging was noted in the fourth patient after 9 months. A revision adding cancellous bone grafts and resorting to an intramedullary fixation led to a success.
4例患者报告。
全踝关节置换失败后通过踝关节融合恢复无痛步态。
全踝关节置换松动或感染。
全身健康状况差。患者依从性差。
取出全关节组件。用取自同侧髂嵴的三层皮质骨移植填充缺损并进行内固定。怀疑感染时，建议采用两阶段手术，第一阶段包括取出组件、细致清创并用含庆大霉素的聚甲基丙烯酸甲酯（PMMA）珠填充缺损。第二阶段：关节融合。
4例患者中有2例手术目标达成且无并发症。第4例患者在9个月后未发现骨桥形成。通过增加松质骨移植并采用髓内固定进行翻修取得成功。
