Trauma and Foor/Ankle Services, Tampa General Hospital, Tampa, FL, USA.
Foot Ankle Int. 2011 Jun;32(6):581-8. doi: 10.3113/FAI.2011.0581.
Pantalar arthrodesis is an important salvage option for stabilizing the hindfoot and salvaging the limb following trauma or collapse. This report evaluates the healing rates and complications which occur in diabetics and post-traumatic patients.
Twenty patients presenting with post-traumatic arthritis of the ankle-hindfoot (twelve) or with Type II or Type IIIA Charcot arthropathy (eight) were managed with a pantalar fusion. Followup averaged 46 months. Patients were evaluated using the Short Form-36 (SF-36), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, the Short Musculoskeletal Function Assessment (SMFA) and the Visual Analog Pain Scale (VAS).
There were no amputations in either group. Casting averaged 14.9 weeks, full weightbearing was achieved at 25.1 weeks and time to union averaged 44.1 weeks. Average age was 56.3 yrs. and BMI averaged 34.2. Fourteen patients (70%) had their surgery performed in multiple stages. Acceptable outcomes were noted for all patients for the SF-36, AOFAS and SMFA scores. VAS scores averaged 2.2. There were ten complications (50%); four patients (two in each group) required additional surgery.
Pantalar arthrodesis is a reasonable salvage option for patients with severe post traumatic arthropathy and neuropathic arthropathy. Patients should be informed of the increased risks as well as the long periods of postoperative immobilization and nonweightbearing. We believe a pantalar arthrodesis can produce acceptable outcomes regardless of the cause of disability, with a staged or single approach, and whether the surgery is performed with plates and screws or an intramedullary device.
距下关节融合术是一种重要的挽救方案，可稳定足后和挽救创伤或塌陷后的肢体。本报告评估了糖尿病患者和创伤后患者发生的愈合率和并发症。
20 例患者患有创伤后踝关节-后足关节炎（12 例）或 II 型或 IIIA 型夏科氏关节病（8 例），采用距下关节融合术治疗。平均随访 46 个月。使用简短形式 36 项健康调查简表（SF-36）、美国矫形足踝协会（AOFAS）踝关节-后足评分、简短肌肉骨骼功能评估（SMFA）和视觉模拟疼痛量表（VAS）对患者进行评估。
两组均无截肢。平均固定 14.9 周，25.1 周时完全负重，平均愈合时间为 44.1 周。平均年龄为 56.3 岁，BMI 平均为 34.2。14 例（70%）患者分多阶段进行手术。所有患者的 SF-36、AOFAS 和 SMFA 评分均为可接受。VAS 评分为 2.2。有 10 例并发症（50%）；两组各有 2 例患者需要进一步手术。
距下关节融合术是严重创伤后关节炎和神经病变性关节炎患者的一种合理挽救方案。应告知患者增加的风险，以及术后长时间的固定和不负重。我们认为，无论残疾的原因是什么，采用分期或单一方法，使用钢板和螺钉或髓内装置，距下关节融合术都可以产生可接受的结果。
