BG Trauma Center Hamburg, Bergedorfer Str. 10, 21033 Hamburg, Germany.
Eur J Med Res. 2010 Feb 26;15(2):54-8. doi: 10.1186/2047-783x-15-2-54.
Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82), 104 patients were male (67.1%). Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AOFAS-Score and radiographs. 92.7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5%) the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63.7 (53-92). Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection.
虽然踝关节融合术的内固定有明显的趋势，但普遍认为，对于创伤后感染的病例，需要外固定。我们回顾性评估了三角架外固定治疗踝关节创伤后感染的技术和临床长期结果。1993 年至 2006 年，我们连续收治了 155 例踝关节感染患者。其中 133 例为晚期“Gächter”III 期和 IV 期患者行融合术治疗。我们采用两步治疗方案治疗患者。彻底清创和病灶清除后，切除内外踝和关节面。首先应用 AO 固定器，胫骨和跟骨各插入两根斯氏针，临时用庆大霉素珠填充间隙。4 周后进行自体植骨。通过病历评估创伤史、医疗投诉、进一步的损伤和疾病、行走和疼痛状况以及职业问题。指数手术时的平均年龄为 49.7 岁（18-82 岁），104 例为男性（67.1%）。平均 4.5 年后的随访检查包括标准问卷和临床检查，包括 AOFAS 评分和 X 线标准。92.7%的病例融合稳定。5 例融合部分稳定。6 例（4.5%）患者在治疗过程中感染无法控制。这些患者需要进行膝下截肢。随访时的平均 AOFAS 评分为 63.7（53-92）。总体上仍有高度的残疾。并发症发生率和降低的患者舒适度使这种方法主要适用于感染。对于早期 I 期和 II 期感染，大多数病例都可以进行关节挽救。
