Department of Orthopedics, Slotervaartziekenhuis, Amsterdam, the Netherlands.
Acta Orthop. 2010 Feb;81(1):142-7. doi: 10.3109/17453671003628764.
Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease.
Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction.
Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles.
Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good.
全踝关节置换术（TAA）近年来越来越受欢迎。然而，如果手术失败，挽救性融合术必须作为一种可靠的补救措施。因此，我们对一组连续患者的挽救性融合术后的临床、影像学和主观结果进行了研究，并集中研究了固定方法对融合率和炎症性关节病挽救的影响。
1994 年至 2005 年间，对 18 例踝关节（18 例患者）进行了挽救性融合术。15 例诊断为炎症性关节病（IJD），3 例为骨关节炎（OA）。7 例采用胫距融合，11 例采用胫距跟融合。对连续影像学检查的愈合时间进行研究。通过 AOFAS 评分、足部功能指数（FFI）和疼痛、功能和满意度的 VAS 评分，对末次随访时的临床结果进行测量。
7 例（4 例 IJD，3 例 OA）采用刀片钢板固定；均愈合。其他方法固定的 11 例风湿性踝关节中有 7 例出现不愈合。11 例患者（8 例融合踝关节，3 例不愈合）可进行临床评估。他们的 AOFAS 评分平均为 62，总体 FFI 平均为 70。疼痛 VAS 评分为 20，功能为 64，满意度为 74。融合和不融合踝关节的评分相似。
刀片钢板固定在 TAA 失败后的挽救性融合术中是成功的。其他固定方法治疗 IJD 的挽救性踝关节融合术后，发现高不愈合率。临床结果为良好至尚可。
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