Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea.
Arthroscopy. 2010 Feb;26(2):230-8. doi: 10.1016/j.arthro.2009.07.008. Epub 2009 Dec 21.
The purpose of this study was to evaluate the results of posterior arthroscopic subtalar arthrodesis (ASTA) by use of a posterior 2-portal approach in the prone position and to describe the surgical technique.
Between September 2004 and December 2006, posterior ASTA was performed in 16 patients (all men) with post-traumatic subtalar arthritis after an intra-articular fracture of the calcaneus. The mean age was 44 years (range, 20 to 64 years). The mean follow-up period was 30 months (range, 20 to 46 months). According to the Sanders classification of calcaneal fractures, 2 patients had type IIA fractures, 3 had type IIIB fractures, 6 had type IIIAC fractures, and 5 had type IIIBC fractures. The technique involved using posteromedial and posterolateral portals in the prone position, posterior talocalcaneal facet debridement, and percutaneous posterior fixation with 2 cannulated screws. Clinical results were evaluated by use of the ankle-hindfoot scale of the American Orthopaedic Foot & Ankle Society (AOFAS), the Angus and Cowell scoring system, and postoperative complications. To assess union rate and time to union, radiographic evaluations were also performed.
The mean modified AOFAS score (maximum, 94 points) improved from 35 points (range, 24 to 45 points) preoperatively to 84 points (range, 71 to 94 points) at final follow-up. According to the Angus and Cowell criteria, 13 patients had a good rating, 2 had a fair rating, and 1 had a poor rating because of nonunion. The union rate was 94% at a mean of 11 weeks, and nonunion occurred in 1 case. No other postoperative complications occurred.
ASTA in the prone position through a posterior 2-portal approach provided safe access and superior visualization of the posterior talocalcaneal facet and easy fixation of posterior screws. This technique also provided good clinical outcomes (good results in 81% of patients according to the Angus and Cowell scoring system and a mean modified AOFAS score of 84 points) and a 94% union rate at a mean of 11 weeks.
本研究旨在评估采用后入路两切口（后路 2 切口）俯卧位后关节镜下距下关节融合术（ASTA）的治疗效果，并介绍该手术技术。
2004 年 9 月至 2006 年 12 月，我们对 16 例（均为男性）创伤性距下关节炎患者（均为跟骨关节内骨折后）行后入路 ASTA。患者的平均年龄为 44 岁（范围，20 至 64 岁）。平均随访时间为 30 个月（范围，20 至 46 个月）。根据 Sanders 跟骨骨折分型，2 例为ⅡA型，3 例为ⅢB 型，6 例为ⅢAC 型，5 例为ⅢBC 型。手术采用俯卧位时的后内侧和后外侧入路，后距下关节面清理，以及经皮后 2 枚空心螺钉固定。采用美国矫形足踝协会（AOFAS）踝-后足评分、Angus 和 Cowell 评分系统以及术后并发症评估临床疗效。为评估融合率和融合时间，还进行了影像学评估。
平均改良 AOFAS 评分（最高 94 分）从术前的 35 分（范围，24 至 45 分）改善至末次随访时的 84 分（范围，71 至 94 分）。根据 Angus 和 Cowell 标准，13 例为优，2 例为良，1 例为差（因不愈合）。平均 11 周时融合率为 94%，1 例发生不愈合。无其他术后并发症发生。
后路 2 切口俯卧位 ASTA 可提供安全的入路和后距下关节面的良好显露，便于固定后螺钉。该技术还可获得良好的临床效果（根据 Angus 和 Cowell 评分系统，81%的患者为优，平均改良 AOFAS 评分为 84 分），平均 11 周时融合率为 94%。
