Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
Clin Orthop Surg. 2010 Mar;2(1):1-7. doi: 10.4055/cios.2010.2.1.1. Epub 2010 Feb 4.
Ankle arthrodesis and replacement are two common surgical treatment options for end-stage ankle osteoarthritis. However, the relative value of these alternative procedures is not well defined. This study compared the clinical and radiographic outcomes as well as the early perioperative complications of the two procedures.
Between January 2, 1998 and May 31, 2002, 138 patients were treated with ankle fusion or replacements. Seventy one patients had isolated posttraumatic or primary ankle arthritis. However, patients with inflammatory arthritis, neuropathic arthritis, concomitant hind foot fusion, revision procedures and two component system ankle replacement were excluded. Among them, one group of 42 patients had a total ankle replacement (TAR), whereas the other group of 29 patients underwent ankle fusion. A complete follow-up could be performed on 89% (37/42) and 73% (23/29) of the TAR and ankle fusion group, respectively. The mean follow-up period was 4.2 years (range, 2.2 to 5.9 years).
The outcomes of both groups were compared using a student's t-test. Only the short form heath survery mental component summary score and Ankle Osteoarthritis Scale pain scale showed significantly better outcomes in the TAR group (p < 0.05). In the radiographic evaluation, there was no significant difference in preoperative and postoperative osteoarthritis between the TAR and fusion groups.
The clinical results of TAR are similar to those of fusion at an average follow-up of 4 years. However, the arthroplasty group showed better pain relief and more postoperative complications that required surgery.
踝关节融合和置换是治疗终末期踝关节骨关节炎的两种常见手术治疗选择。然而，这两种替代手术的相对价值尚未明确界定。本研究比较了两种手术的临床和影像学结果以及早期围手术期并发症。
1998 年 1 月 2 日至 2002 年 5 月 31 日，对 138 例患者进行了踝关节融合或置换手术。71 例患者为单纯创伤后或原发性踝关节关节炎。然而，患有炎症性关节炎、神经性关节炎、同时行后足融合、翻修手术和双组件系统踝关节置换术的患者被排除在外。其中，一组 42 例患者行全踝关节置换术（TAR），另一组 29 例患者行踝关节融合术。分别对 TAR 组和踝关节融合组的 89%（37/42）和 73%（23/29）患者进行了完整随访。平均随访时间为 4.2 年（范围，2.2 至 5.9 年）。
使用学生 t 检验比较两组的结果。仅 TAR 组的短形式健康调查心理成分综合评分和踝关节骨关节炎量表疼痛评分显示出显著更好的结果（p < 0.05）。在影像学评估中，TAR 组和融合组在术前和术后的骨关节炎方面无显著差异。
在平均 4 年的随访中，TAR 的临床结果与融合相似。然而，关节成形术组的疼痛缓解更好，但术后并发症更多，需要手术治疗。
