新型三组件植入物的全踝关节置换术。

Total ankle replacement with use of a new three-component implant.

机构信息

Department of Orthopaedic Surgery, Foot and Ankle Center, Schulthess Clinic, Zurich, Switzerland.

出版信息

J Bone Joint Surg Am. 2011 Aug 3;93(15):1426-35. doi: 10.2106/JBJS.J.00913.

DOI:10.2106/JBJS.J.00913

PMID:21915548

Abstract

BACKGROUND

Total ankle arthroplasty has evolved over the past decade, and newer three-component implants have demonstrated favorable clinical results and improved survivorship. The present study analyzed the clinical and radiographic results of the first 240 total ankle arthroplasties performed by the authors with one of these new three-component prostheses.

METHODS

Two hundred and forty consecutive primary total ankle arthroplasties were performed in 233 patients (115 women and 118 men; mean age, 61.6 years) between November 2003 and October 2007 with the Mobility prosthesis. Intraoperative and postoperative complications, reoperations, and failures were recorded. The American Orthopaedic Foot & Ankle Society hindfoot score and a visual analog scale score assessment of pain were determined at each follow-up visit. Range of ankle motion was measured on functional radiographs, and the radiographs were studied to assess component positioning, radiolucencies, new bone formation, and periprosthetic bone cysts.

RESULTS

Two hundred and thirty-three of the arthroplasties were available for follow-up at least one year after surgery. The mean duration of follow-up was 32.8 ± 15.3 months. There were ten intraoperative complications (4.2%) and twenty postoperative complications (8.6%). A reoperation was necessary in eighteen ankles (7.7%). Five arthroplasties (2.1%) failed at a mean of twenty-seven months after surgery. The mean American Orthopaedic Foot & Ankle Society hindfoot score improved from 48.2 to 84.1 points (p < 0.001). The mean pain level decreased from 7.7 to 1.7 points (p < 0.001). The mean total range of ankle motion improved from 19.8° to 21.9° (p < 0.001). The tibial component had a mean of 2.1° of varus and a mean posterior slope of 6.0° relative to the tibial axis. The prevalence of nonprogressive radiolucency ranged from 1.8% to 37.3% in the ten zones surrounding the tibial component, and from 0 to 2.2% in the three zones surrounding the talar component.

CONCLUSIONS

The short-term clinical and radiographic results after Mobility total ankle arthroplasty are encouraging and are at least comparable with those associated with other modern three-component implants. The minimum duration of follow-up of one year is short, and studies with longer follow-up are needed to confirm our findings.

摘要

背景

在过去的十年中，全踝关节置换术不断发展，新型的三组件植入物已显示出良好的临床效果和更高的生存率。本研究分析了作者使用其中一种新型三组件假体进行的 240 例初次全踝关节置换术的临床和影像学结果。

方法

2003 年 11 月至 2007 年 10 月期间，使用 Mobility 假体对 233 例（115 例女性，118 例男性；平均年龄 61.6 岁）患者的 240 例连续原发性全踝关节置换术进行了分析。记录了术中及术后并发症、再次手术和失败情况。在每次随访时，采用美国矫形足踝协会后足评分和疼痛视觉模拟评分评估疼痛。在功能 X 线片上测量踝关节活动范围，并对 X 线片进行研究以评估组件位置、透亮区、新骨形成和假体周围骨囊肿。

结果

233 例关节置换术后至少随访 1 年。平均随访时间为 32.8±15.3 个月。术中并发症 10 例（4.2%），术后并发症 20 例（8.6%）。18 例（7.7%）需要再次手术。5 例（2.1%）假体在术后平均 27 个月失败。美国矫形足踝协会后足评分由 48.2 分提高至 84.1 分（p＜0.001）。疼痛评分由 7.7 分降至 1.7 分（p＜0.001）。踝关节总活动范围由 19.8°改善至 21.9°（p＜0.001）。胫骨组件平均内翻 2.1°，胫骨轴后倾 6.0°。胫骨组件周围 10 个区域的非进展性透亮区发生率为 1.8%～37.3%，距骨组件周围 3 个区域的发生率为 0～2.2%。