Department of Orthopaedic Surgery, University of Calgary, Calgary, Canada.
Clin Orthop Relat Res. 2010 Jan;468(1):209-16. doi: 10.1007/s11999-009-0948-x. Epub 2009 Jun 25.
A structural graft often is needed to fill gaps during reconstructive procedures of the ankle and hindfoot. Autograft, the current gold standard, is limited in availability and configuration and is associated with donor-site morbidity in as much as 48%, whereas the alternative allograft carries risks of disease transmission and collapse. Trabecular metal (tantalum), with a healing rate similar to that of autograft, high stability, and no donor-site morbidity, has been used in surgery of the hip, knee, and spine. However, its use has not been documented in foot and ankle surgery. We retrospectively reviewed nine patients with complex foot and ankle arthrodeses using a tantalum spacer. Minimum followup was 1.9 years (average, 2 years; range, 1.9-2.4 years). Bone ingrowth into the tantalum was analyzed with micro-CT in three of the nine patients. All arthrodeses were fused clinically and radiographically at the 1- and 2 year followups and no complications occurred. The American Orthopaedic Foot and Ankle Society score increased from 32 to 74. The micro-CT showed bony trabeculae growing onto the tantalum. Our data suggest tantalum may be used as a structural graft option for ankle and subtalar arthrodesis. All nine of our patients achieved fusion and had no complications. Using tantalum obviated the need for harvesting of the iliac spine.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
在踝关节和后足重建手术中，经常需要结构性移植物来填补间隙。自体移植物是目前的金标准，但存在可用性和构型限制，并且与 48%的供体部位发病率相关，而替代同种异体移植物则存在疾病传播和塌陷的风险。多孔钽（tantalum）具有类似于自体移植物的愈合率、高稳定性和无供体部位发病率，已在髋关节、膝关节和脊柱手术中使用。然而，其在足踝外科手术中的应用尚未有文献记载。我们回顾性分析了 9 例使用多孔钽 spacer 进行复杂足踝关节融合术的患者。最少随访时间为 1.9 年（平均 2 年；范围 1.9-2.4 年）。对 9 例患者中的 3 例进行了微 CT 分析，以评估钽骨内生长情况。所有融合术在 1 年和 2 年随访时均在临床和影像学上融合，无并发症发生。美国矫形足踝协会评分从 32 分增加到 74 分。微 CT 显示骨小梁长入钽中。我们的数据表明，钽可作为踝关节和距下关节融合的结构性移植物选择。我们的 9 例患者均融合，且无并发症。使用钽避免了髂嵴的采集。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
