Provelengios Stefanos, Papavasiliou Kyriakos A, Kyrkos Margaritis J, Kirkos John M, Kapetanos George A
3rd Orthopaedic Department, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, Thessaloniki, Greece.
J Bone Joint Surg Am. 2009 Mar 1;91(3):575-83. doi: 10.2106/JBJS.H.00559.
Pantalar arthrodesis is considered by many to be the final operative option before amputation for the treatment of paralytic foot deformities. The aim of the present study was to evaluate the long-term results of pantalar arthrodesis with regard to its impact on the adjacent joints and the walking ability of patients with paralytic foot deformities.
Twenty-four patients (seventeen men and seven women) who underwent a one-stage pantalar arthrodesis between 1953 and 1973 for the treatment of sequelae of poliomyelitis were reevaluated. All patients underwent a physical and radiographic examination, and all completed the Short Form-36 questionnaire and a pantalar arthrodesis-specific questionnaire.
The average age of the patients was twenty years at the time of the operation and 57.2 years at the time of the latest evaluation. The average duration of follow-up was 37.2 years. Eleven patients had development of immediate postoperative complications, including wound-healing problems (nine) and infections (two). The long-term results, however, were good (mean Short Form-36 scores, 73 of 100 points [overall], 51.5 points [physical functioning], and >70 points [all other domains]). Sixteen patients experienced repeated episodes of ipsilateral knee pain; most (fifteen) of these patients experienced a gradual onset of this pain, starting at an average of 20.8 years (range, fifteen to thirty years) postoperatively. The position of the fused ankle did not appear to have a significant impact on the development of ipsilateral knee pain or the time interval between the pantalar arthrodesis and the onset of ipsilateral knee pain.
Pantalar arthrodesis effectively stabilizes the ankle, hindfoot, and midfoot in patients with severe paralytic deformities. Even though most patients can be expected to have development of osteoarthritis of the ipsilateral knee, it seems that a successfully performed pantalar arthrodesis in carefully selected cases is a reliable operative option offering a strong and stable foot that will function well for many years.
对于麻痹性足部畸形的治疗，距下关节融合术被许多人视为截肢前的最终手术选择。本研究的目的是评估距下关节融合术对相邻关节的影响以及对麻痹性足部畸形患者行走能力的长期效果。
对1953年至1973年间接受一期距下关节融合术治疗小儿麻痹后遗症的24例患者（17例男性和7例女性）进行重新评估。所有患者均接受了体格检查和影像学检查，并完成了简短健康调查问卷（Short Form-36）和一份距下关节融合术特异性问卷。
患者手术时的平均年龄为20岁，最近一次评估时为57.2岁。平均随访时间为37.2年。11例患者术后立即出现并发症，包括伤口愈合问题（9例）和感染（2例）。然而，长期效果良好（简短健康调查问卷平均得分，总分100分中的73分，身体功能51.5分，其他所有领域均>70分）。16例患者同侧膝关节疼痛反复发作；其中大多数患者（15例）疼痛逐渐出现，平均术后20.8年（范围为15至30年）开始。融合踝关节的位置似乎对同侧膝关节疼痛的发生或距下关节融合术与同侧膝关节疼痛发作之间的时间间隔没有显著影响。
距下关节融合术可有效稳定重度麻痹性畸形患者的踝关节、后足和中足。尽管大多数患者预计会出现同侧膝关节骨关节炎，但在精心挑选的病例中成功实施距下关节融合术似乎是一种可靠的手术选择，可提供坚固稳定的足部，使其多年来功能良好。
