Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Liestal, Switzerland.
J Bone Joint Surg Am. 2011 Nov 2;93(21):1969-78. doi: 10.2106/JBJS.J.01415.
Total ankle replacement has become an increasingly popular treatment for patients with end-stage ankle osteoarthritis. The surgery is technically demanding and generally performed by only experienced foot and ankle surgeons. An important complication of total ankle replacement is malposition of the talar component. The biomechanical effect of malposition has been reported; however, the functional outcomes of patients with varying degrees of talar component malposition have not. The purpose of this study was to assess the influence of talar component malposition on postoperative pain relief and functional outcome.
This retrospective cohort study included 317 total ankle replacements in 317 patients. The anteroposterior offset ratio was measured with use of lateral ankle radiographs made with the patient in a standing, weight-bearing position. Patients were classified into one of three groups: those with an anteroposterior offset ratio of 0 (127 ankles), those with a ratio of >0 (103 ankles), and those with a ratio of <0 (eighty-seven ankles). Postoperative pain relief was assessed with use of a visual analogue scale. Functional outcome was assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and measurement of ankle range of motion. The mean duration of follow-up (and standard deviation) was 53.2 ± 18.4 months (range, twenty-four to ninety-eight months).
The postoperative pain level in the group with an anteroposterior offset ratio of 0 was significantly lower than that for both the group with a ratio of >0 (p < 0.001) and the group with a ratio of <0 (p = 0.017). Also, the functional outcome, measured with use of the AOFAS hindfoot score, was significantly higher, and ankle motion was significantly greater, in the group with an anteroposterior offset ratio of 0 than in the group with a ratio of >0 (p = 0.003 and p < 0.001, respectively) and the group with a ratio of <0 (p = 0.007 and p = 0.080).
The anteroposterior offset ratio may be a useful predictor of outcome in patients with total ankle replacement with regard to both pain and function.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
全踝关节置换术已成为治疗终末期踝关节骨关节炎患者的一种越来越受欢迎的治疗方法。该手术技术要求高，通常仅由经验丰富的足踝外科医生进行。全踝关节置换术的一个重要并发症是距骨组件位置不当。已经报道了位置不当的生物力学影响；然而，距骨组件位置不同的患者的功能结果尚未报道。本研究的目的是评估距骨组件位置不当对术后疼痛缓解和功能结果的影响。
本回顾性队列研究纳入了 317 名患者的 317 例全踝关节置换术。在患者站立、负重位时拍摄侧位踝关节 X 线片，测量前后偏移比。患者分为三组：前后偏移比为 0（127 例）、大于 0（103 例）和小于 0（87 例）。术后疼痛缓解程度采用视觉模拟评分法评估。功能结果采用美国矫形足踝协会（AOFAS）后足评分和踝关节活动范围测量。平均随访时间（及标准差）为 53.2 ± 18.4 个月（24-98 个月）。
前后偏移比为 0 的组术后疼痛水平明显低于前后偏移比大于 0（p < 0.001）和小于 0（p = 0.017）的组。此外，使用 AOFAS 后足评分测量的功能结果明显更高，且踝关节活动度明显大于前后偏移比大于 0 的组（p = 0.003 和 p < 0.001）和前后偏移比小于 0 的组（p = 0.007 和 p = 0.080）。
前后偏移比可能是全踝关节置换术后疼痛和功能结果的有用预测指标。
预后 II 级。有关证据水平的完整描述，请参见作者说明。
