Besse Jean-Luc, Brito Nuno, Lienhart Christophe
Université de Lyon., Univ. Lyon 1 F-69622, Villeurbanne, France.
Foot Ankle Int. 2009 Oct;30(10):964-75. doi: 10.3113/FAI.2009.0964.
AES mobile-bearing total ankle replacement is evolved from the Buechel Pappas model. We report medium-term results of a prospective study with AES.
All patients who underwent AES TAR for ankle arthritis, by a single surgeon, from 2003 to 2006 were included, excluding neurologic disease, talar osteonecrosis and malalignment more than 20 degrees. All were reviewed at 6 months, 1 year, and at yearly intervals thereafter. X-rays were analyzed by three observers, using a 10-zone protocol. Fifty consecutive AES implants in 47 patients (mean age, 56 years; range, 21 to 79 year) were included, with at least 2 years' followup (mean 40 months). Preoperative diagnosis was mainly post-traumatic (50%) and osteoarthritis secondary to instability (36%). Associated procedures were performed in 38%.
Eighty-two percent had good functional results. The mean AOFAS score rose from 36.9 +/- 1.7 preoperatively to 85.4 +/- 12, dorsiflexion from 3 degrees to 7.3 degrees, and plantarflexion from 30.8 degrees to 37.8 degrees. Two ankles underwent secondary arthrodesis for talar subsidence and mechanical dislocation. Ninety-eight percent of implants were well positioned at 90 degrees +/-4. Mean prosthesis ROM on X-ray was 22.1 degrees. There were tibia/implant interface cysts (greater than 5 mm) in 62% of cases, and talar/implant interface cysts in 43%.
Although functional outcomes were comparable to the other mobile TAR in the literature, bone lysis with the AES prosthesis was more frequent with risk of subsidence. We therefore stopped implantation of this prosthesis and recommend preventive grafting for severe lysis.
AES活动轴承全踝关节置换术由比歇尔·帕帕斯模型发展而来。我们报告了一项关于AES的前瞻性研究的中期结果。
纳入2003年至2006年间由同一外科医生为踝关节关节炎患者施行AES全踝关节置换术的所有患者，排除神经疾病、距骨骨坏死以及超过20度的畸形。所有患者在术后6个月、1年及此后每年接受复查。由三名观察者采用10分区方案分析X线片。纳入47例患者（平均年龄56岁；范围21至79岁）的连续50例AES植入物，随访至少2年（平均40个月）。术前诊断主要为创伤后（50%）和继发于不稳定的骨关节炎（36%）。38%的患者进行了相关手术。
82%的患者功能结果良好。美国足踝外科协会（AOFAS）平均评分从术前的36.9±1.7提高到85.4±12，背屈从3度提高到7.3度，跖屈从30.8度提高到37.8度。两个踝关节因距骨下沉和机械性脱位接受了二次关节融合术。98%的植入物在90度±4时位置良好。X线片上假体的平均活动范围为22.1度。62%的病例存在胫骨/植入物界面囊肿（大于5毫米），43%的病例存在距骨/植入物界面囊肿。
尽管功能结果与文献中其他活动轴承全踝关节置换术相当，但AES假体的骨溶解更常见，有下沉风险。因此，我们停止了该假体的植入，并建议对严重骨溶解进行预防性植骨。
