Sammarco Vincent J, Magur Edward G, Sammarco G James, Bagwe Mahesh R
Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH 45219, USA.
Foot Ankle Int. 2006 Sep;27(9):661-6. doi: 10.1177/107110070602700901.
Triple arthrodesis has long been used for the treatment of painful malalignment or arthritis of the hindfoot. However, the effect of fusion on adjacent joints has sparked interest in a more limited arthrodesis in patients without involvement of the calcaneocuboid joint.
Results of 16 feet in 14 patients who had a modified double arthrodesis for symptomatic flatfoot, cavovarus deformity, or hindfoot arthritis were reviewed retrospectively with a minimum followup of 18 (range 18 to 93) months. The most common diagnosis contributing to the hindfoot deformity was pes planovalgus. All operations were done with a consistent technique using rigid internal fixation with screws. In 15 feet, a concomitant gastrocnemius recession for equinus contracture was done at the time of the primary surgery. Clinical evaluation was based on the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale in addition to subjective assessments of pain, function, shoewear, cosmesis, and overall satisfaction. Radiographic evaluation included measurements of the anterior-posterior talo-second metatarsal angle, lateral talocalcaneal angle, and lateral talo-first metatarsal angle, and notation of arthritic changes of the ankle, calcaneocuboid, and midfoot joints, as well as an assessment of time to union of all arthrodeses.
The average AOFAS Ankle-Hindfoot Scale improved from 44.7 preoperatively to 77.0 postoperatively (p < 0.01). Subjectively, patients experienced improvements in pain, function, cosmesis, and shoewear. Overall, all patients were satisfied and would have the procedure again under similar circumstances. Radiographically, all parameters statistically improved. There was an increase in arthritic scores for six ankle, six calcaneocuboid, and five midfoot joints. One talonavicular joint nonunion occurred in a rheumatoid patient, requiring revision arthrodesis.
We have concluded that simultaneous arthrodesis of the talonavicular and subtalar joints is a reasonable treatment in the subset of patients with symptomatic hindfoot malalignment whose calcaneocuboid joints are not involved in the primary disease.
三关节融合术长期以来一直用于治疗后足疼痛性畸形或关节炎。然而，融合对相邻关节的影响引发了人们对在未累及跟骰关节的患者中采用更有限融合术的兴趣。
回顾性分析14例患者16足接受改良双关节融合术治疗症状性扁平足、高弓足畸形或后足关节炎的结果，随访时间至少18个月（18至93个月）。导致后足畸形最常见的诊断是扁平外翻足。所有手术均采用一致的技术，使用螺钉进行坚强内固定。15足在初次手术时同时行跟腱延长术以纠正马蹄足挛缩。临床评估基于美国矫形足踝协会（AOFAS）踝 - 后足评分，此外还包括对疼痛、功能、鞋类、美观和总体满意度的主观评估。影像学评估包括测量距骨 - 第二跖骨前后角、外侧距跟角和外侧距骨 - 第一跖骨角，记录踝关节、跟骰关节和中足关节的关节炎变化，以及评估所有融合部位的愈合时间。
AOFAS踝 - 后足评分平均从术前的44.7提高到术后的77.0（p < 0.01）。主观上，患者在疼痛、功能、美观和鞋类方面均有改善。总体而言，所有患者均满意，且在类似情况下愿意再次接受该手术。影像学上，所有参数均有统计学改善。六个踝关节、六个跟骰关节和五个中足关节的关节炎评分增加。一名类风湿患者发生距舟关节不愈合，需要翻修融合术。
我们得出结论，对于原发性疾病未累及跟骰关节的有症状后足畸形患者，同时进行距舟关节和距下关节融合术是一种合理的治疗方法。
