Papageorgiou General Hospital, Ring-Road West, Thessaloniki, Greece.
J Bone Joint Surg Am. 2010 Mar;92 Suppl 1 Pt 1:44-54. doi: 10.2106/JBJS.I.01235.
Pantalar arthrodesis is considered by many to be the final operative option before amputation for the treatment of paralytic foot deformities. The aim of the present study was to evaluate the long-term results of pantalar arthrodesis with regard to its impact on the adjacent joints and the walking ability of patients with paralytic foot deformities.
Twenty-four patients (seventeen men and seven women) who underwent a one-stage pantalar arthrodesis between 1953 and 1973 for the treatment of sequelae of poliomyelitis were reevaluated. All patients underwent a physical and radiographic examination, and all completed the Short Form-36 questionnaire and a pantalar arthrodesis specific questionnaire.
The average age of the patients was twenty years at the time of the operation and 57.2 years at the time of the latest evaluation. The average duration of follow-up was 37.2 years. Eleven patients had development of immediate postoperative complications, including wound-healing problems (nine) and infections (two). The long-term results,however, were good (mean Short Form-36 scores, 73 of 100 points [overall], 51.5 points [physical functioning], and >70 points [all other domains]). Sixteen patients experienced repeated episodes of ipsilateral knee pain; most (fifteen) of these patients experienced a gradual onset of this pain, starting at an average of 20.8 years (range, fifteen to thirty years) postoperatively. The position of the fused ankle did not appear to have a significant impact on the development of ipsilateral knee pain or the time interval between the pantalar arthrodesis and the onset of ipsilateral knee pain.
Pantalar arthrodesis effectively stabilizes the ankle, hindfoot, and midfoot in patients with severe paralytic deformities. Even though most patients can be expected to have development of osteoarthritis of the ipsilateral knee, it seems that a successfully performed pantalar arthrodesis in carefully selected cases is a reliable operative option offering a strong and stable foot that will function well for many years.
对于麻痹性足畸形的治疗，许多人认为 pantalar 关节融合术是截肢前的最后一种手术选择。本研究旨在评估 pantalar 关节融合术的长期结果，包括其对邻近关节的影响以及麻痹性足畸形患者的步行能力。
对 1953 年至 1973 年间因小儿麻痹后遗症接受一期 pantalar 关节融合术的 24 例患者（17 例男性，7 例女性）进行了重新评估。所有患者均接受了体格检查和影像学检查，并完成了 Short Form-36 问卷和 pantalar 关节融合术特定问卷。
患者的平均年龄为手术时 20 岁，末次评估时 57.2 岁。平均随访时间为 37.2 年。11 例患者发生术后即刻并发症，包括伤口愈合问题（9 例）和感染（2 例）。然而，长期结果良好（平均 Short Form-36 评分，总分 100 分中的 73 分[总体]，51.5 分[身体机能]，>70 分[所有其他领域]）。16 例患者出现同侧膝关节反复疼痛；这些患者中大多数（15 例）逐渐出现这种疼痛，平均在术后 20.8 年（15 年至 30 年）开始。融合踝关节的位置似乎对同侧膝关节疼痛的发展或 pantalar 关节融合术与同侧膝关节疼痛发作之间的时间间隔没有显著影响。
pantalar 关节融合术可有效稳定严重麻痹性畸形患者的踝关节、后足和中足。尽管大多数患者预计会发生同侧膝关节骨关节炎，但在精心选择的病例中成功进行的 pantalar 关节融合术似乎是一种可靠的手术选择，可提供稳定而坚固的足部，多年来功能良好。
