关节镜下踝关节融合术：术前畸形是否会影响结果的可重复性？

Arthroscopic ankle arthrodesis: are results reproducible irrespective of pre-operative deformity?

机构信息

Department of Orthopaedic Surgery, Colchester University Hospital, Turner Road, Colchester, Essex CO4 5JL, United Kingdom.

出版信息

Foot Ankle Surg. 2011 Dec;17(4):294-9. doi: 10.1016/j.fas.2010.12.004. Epub 2011 Feb 20.

DOI:10.1016/j.fas.2010.12.004

PMID:22017906

Abstract

BACKGROUND

Arthroscopic ankle arthrodesis is gaining in popularity. It has been shown to have a shorter time to union and less morbidity than traditional open procedures. The arthroscopic technique has been mainly used for ankles with minimal deformity. Our aim was to find out whether we could reproduce the good results of arthroscopic ankle arthrodesis in both minimally and markedly deformed ankles.

METHODS

We reviewed 62 patients who underwent an arthroscopic ankle arthrodesis for end stage arthritis. The average follow up was 63 months (range 21-92 months). Patients were evaluated subjectively and objectively using the Mazur grading system. 4 patients died before final review and 3 were lost to follow-up leaving 55 patients for evaluation. The pre-operative tibiotalar angle in the coronal plane was between 26° valgus and 24° varus. We divided our patients into 2 groups based on the tibiotalar angle. Group A (n=31) had a varus or valgus deformity of less than 15 and Group B (n=24) had a deformity equal to or more than 15°.

RESULTS

The overall fusion rate was 91%. Fusion occurred in 29 of 31 (94%) ankles in Group A compared to 21 of 24 (88%) in Group B (p=0.64).The overall mean time to union was 10.4 weeks. The time to union in Group A was 8.8 weeks compared to 12.7 weeks for Group B (p=0.001). Using the Mazur ankle grading system, 84% of the cases in Group A had a good to excellent result compared to 79% in Group B (p=0.73). There were 2 superficial infections, 2 cases of deep vein thrombosis and 3 patients required removal of prominent screws.

CONCLUSIONS

We have shown that arthroscopic ankle arthrodesis yields reliable and reproducible results in a District General Hospital setting with high union rates, short time to union and low complication rates. It can be satisfactorily employed for ankles with significant deformity, although this resulted in a longer time to union. The end results remain uniformly good to excellent.

摘要

背景

关节镜下踝关节融合术越来越受欢迎。与传统的开放式手术相比，它具有愈合时间更短、发病率更低的优点。关节镜技术主要用于畸形较小的踝关节。我们的目的是了解我们是否可以在畸形程度较小和较大的踝关节中都能重现关节镜下踝关节融合术的良好效果。

方法

我们回顾了 62 例因终末期关节炎行关节镜下踝关节融合术的患者。平均随访时间为 63 个月（21-92 个月）。使用 Mazur 分级系统对患者进行主观和客观评估。4 例患者在最终复查前死亡，3 例患者失访，最终有 55 例患者接受评估。冠状面胫距角术前在 26°外翻和 24°内翻之间。我们根据胫距角将患者分为两组。A 组（n=31）的内翻或外翻畸形小于 15°，B 组（n=24）的畸形等于或大于 15°。

结果

总体融合率为 91%。A 组 31 例踝关节中融合 29 例（94%），B 组 24 例踝关节中融合 21 例（88%）（p=0.64）。总体平均愈合时间为 10.4 周。A 组的愈合时间为 8.8 周，B 组为 12.7 周（p=0.001）。使用 Mazur 踝关节分级系统，A 组 84%的病例结果为优至良，B 组为 79%（p=0.73）。有 2 例浅表感染，2 例深静脉血栓形成，3 例患者需要取出突出的螺钉。