Avon Orthopaedic Centre, Orthopaedics, Southmead Hospital, Bristol, Avon BS10 5NB, United Kingdom.
Foot Ankle Int. 2010 Dec;31(12):1085-92. doi: 10.3113/FAI.2010.1085.
Tibiotalocalcaneal fusion with a straight rod has a risk of damaging the lateral plantar neurovascular structures and may interfere with maintaining normal heel valgus position.We report the results of a prospective study of tibiotalocalcaneal (TTC) arthrodesis with a short, anatomically curved interlocking, intramedullary nail.
Forty-five arthrodesis in 42 patients, performed between Jan 2003 and Oct 2008, were prospectively followed. The mean followup was 48 (range, 10 to 74) months. The main indications for the procedure were failed ankle arthrodesis with progressive subtalar arthritis, failed ankle arthroplasty and complex hindfoot deformity. The outcome was measured by a combination of pre and postoperative clinical examination, AOFAS hindfoot scores, SF-12 scores and radiological assessment.
Union rate was 89% (40/45). Eighty-two percent (37/45) reported improvement in pain and 73% (33/45) had improved foot function. Satisfactory hindfoot alignment was achieved in 84% (38/45). Postoperatively there was a mean improvement in the AOFAS score of 37. Complications included a below knee amputation for persistent deep infection, five nonunions, and three delayed unions. Four nails, six proximal and six distal locking screws were removed for various causes. Other complications included two perioperative fractures, four superficial wound infections and one case of lateral plantar nerve irritation.
With a short, anatomically curved intramedullary nail, we had a high rate of tibiotalocalcaneal fusion with minimal plantar neurovascular complications. We believe a short, curved intramedullary nail, with its more lateral entry point, helped maintain hindfoot alignment.
胫距跟融合伴直杆固定存在损伤足底外侧皮神经血管结构的风险，可能会干扰维持正常跟骨外翻位置。我们报告了使用短的解剖弯曲交锁髓内钉行胫距跟（TTC）关节融合术的前瞻性研究结果。
2003 年 1 月至 2008 年 10 月，前瞻性随访 42 例 45 例 TTC 关节融合术患者。平均随访时间为 48（10-74）个月。该手术的主要适应证为踝关节融合失败伴进行性距下关节炎、踝关节置换失败和复杂的后足畸形。通过术前和术后临床检查、AOFAS 后足评分、SF-12 评分和影像学评估相结合来测量结果。
融合率为 89%（40/45）。82%（37/45）报告疼痛改善，73%（33/45）足部功能改善。84%（38/45）获得满意的后足对线。术后 AOFAS 评分平均改善 37 分。并发症包括 1 例因持续性深部感染而进行的膝下截肢，5 例骨不连和 3 例延迟愈合。因各种原因取出 4 枚髓内钉、6 枚近端和 6 枚远端锁定螺钉。其他并发症包括 2 例围手术期骨折、4 例浅表伤口感染和 1 例外侧足底神经刺激。
使用短的解剖弯曲髓内钉，我们获得了很高的胫距跟融合率，同时很少发生足底皮神经血管并发症。我们认为短的、弯曲的髓内钉，其更外侧的进钉点有助于维持后足对线。
