Niinimäki Tuukka Timo, Klemola Tero-Matti, Leppilahti Juhana Ilmari
Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital PL21, FIN-90029 OYS, Oulu, Finland.
Foot Ankle Int. 2007 Apr;28(4):431-4. doi: 10.3113/FAI.2007.0431.
Tibiotalocalcaneal arthrodesis is a treatment modality for severe arthrosis and malalignment of the hindfoot. Complications, such as delayed union and nonunion, are well-known risks of the procedure. Arthrodesis can be done with a plate, screws, an external fixator, or an intramedullary nail. Compression with an intramedullary nail was the focus of this report.
Thirty-four consecutive patients (23 men and 11 women) with an average age range of 57 (range 25-77) years had tibiotalocalcaneal arthrodesis using retrograde intramedullary compression nail fixation. Mean followup was 24 (range 6 to 43) months. One patient died of an unrelated cause, but 30 (91%) of the remaining 33 patients answered the questionnaire.
Bony consolidation was achieved in 26 (76%) patients, the mean time to fusion being 16 weeks. Five patients (15%) had complications and seven (20%) had repeat surgery. Of the 30 patients who responded to the questionnaire, three patients (10%) evaluated the overall result subjectively as being of no benefit and 27 (90%) as improved. The visual analog scale (VAS) score for preoperative pain was 66 at rest and 83 when walking, and the mean postoperative scores were 19 and 32, respectively (p<0.001).
Tibiotalocalcaneal arthrodesis with a compressive retrograde intramedullary nail is an effective and safe procedure for patients with severe malalignment or arthrosis of the hindfoot. It is essentially a salvage procedure, and most patients benefit from it, but excellent results are rare.
胫距跟关节融合术是治疗后足严重关节病和畸形排列的一种治疗方式。诸如骨愈合延迟和骨不连等并发症是该手术众所周知的风险。关节融合术可使用钢板、螺钉、外固定器或髓内钉来完成。本报告重点关注髓内钉加压固定。
连续34例患者（23例男性和11例女性），平均年龄57岁（范围25 - 77岁），采用逆行髓内加压钉固定进行胫距跟关节融合术。平均随访时间为24个月（范围6至43个月）。1例患者死于无关原因，但其余33例患者中有30例（91%）回答了问卷。
26例（76%）患者实现了骨融合，平均融合时间为16周。5例患者（15%）出现并发症，7例（20%）接受了再次手术。在回答问卷的30例患者中，3例患者（10%）主观评估总体结果无益处，27例（90%）评估为改善。术前静息时视觉模拟量表（VAS）疼痛评分为66分，行走时为83分，术后平均评分分别为19分和32分（p<0.001）。
对于后足严重畸形排列或关节病患者，采用加压逆行髓内钉进行胫距跟关节融合术是一种有效且安全的手术。它本质上是一种挽救性手术，大多数患者从中受益，但极少能获得极佳结果。
