Clements J Randolph
Virginia Tech-Carilion School of Medicine, Carilion Clinic Orthopaedics, Roanoke, VA 24014, USA.
J Foot Ankle Surg. 2012 Jan-Feb;51(1):83-6. doi: 10.1053/j.jfas.2011.09.002. Epub 2011 Oct 20.
Surgical treatment for traumatic dislocation of the talus is a challenging procedure that is often associated with complications. Application of allograft cellular bone matrix with viable mesenchymal stem and osteoprogenitor cells can eliminate the need for autograft and may increase fusion rates in procedures such as tibiocalcaneal arthrodesis. This report describes the treatment of an adult man who presented with a right ankle fracture and subtalar joint dislocation after a motor vehicle accident. After initial treatment with open reduction and internal fixation, the patient developed avascular necrosis of the talus and septic arthritis of the tibiotalar and subtalar joints. After treatment of the infection, the patient was ultimately treated with multistage talectomy and tibiocalcaneal arthrodesis augmented with a cellular bone allograft. Approximately 3 months after the final operation, plain radiographs and computed tomography confirmed solid fusion at the arthrodesis interface. The patient's recovery was uneventful thereafter, and amputation was avoided. This case, which presented additional challenges because of the large defect created by the infection, suggests that use of an allograft cellular bone matrix has the potential to replicate the bone-healing properties of autograft without the constraints and morbidity associated with autograft harvesting.
距骨创伤性脱位的手术治疗是一项具有挑战性的操作，且常伴有并发症。应用含有存活间充质干细胞和骨祖细胞的同种异体骨细胞基质可避免自体骨移植的需求，并可能提高诸如胫跟关节融合术等手术的融合率。本报告描述了一名成年男性在机动车事故后出现右踝关节骨折和距下关节脱位的治疗情况。在进行切开复位内固定的初始治疗后，患者出现了距骨缺血性坏死以及胫距关节和距下关节的化脓性关节炎。在感染得到治疗后，患者最终接受了分期距骨切除术和采用同种异体骨细胞移植增强的胫跟关节融合术。最后一次手术后约3个月，X线平片和计算机断层扫描证实融合界面处牢固融合。此后患者恢复顺利，避免了截肢。由于感染造成的大缺损，该病例带来了额外的挑战，这表明使用同种异体骨细胞基质有可能复制自体骨的骨愈合特性，而没有与自体骨采集相关的限制和发病率。
