Jehan Shah, Shakeel Mohammad, Bing Andrew J F, Hill Simon Owain
The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK.
Acta Orthop Belg. 2011 Oct;77(5):644-51.
Tibiotalocalcaneal arthrodesis with an intramedullary nail may find indications for a variety of conditions of the hindfoot. We performed a systematic review of the literature primarily to find out the union rates and complications of tibiotalocalcaneal arthrodesis with an intramedullary nail. We included 33 studies for this review. These studies included 631 patients who had 659 procedures. Eighteen cases were excluded and 641 joints (613 patients) were available for the final analysis. We analysed the indications, union rates, complications and re-operation rates. The union rate was 86.7% with an average union time of 4.5 months. The complication rate was 55.7%. Metalwork related complications made a significant proportion of all the complications. The re-operation rate was 22%. Revision arthrodesis was done in 3% and amputation in 1.5% the cases. The review indicates that tibiotalocalcaneal arthrodesis with an intramedullary nail has a relatively good union rate but a high rate of complications. Majority of the complications are related to the metalwork. The suggested strategies to minimise these complications are discussed.
髓内钉固定的胫距跟关节融合术可用于多种后足疾病。我们对文献进行了系统回顾，主要目的是了解髓内钉固定的胫距跟关节融合术的骨愈合率和并发症情况。本综述纳入了33项研究。这些研究包括631例患者，共进行了659例手术。排除18例，最终分析纳入641个关节（613例患者）。我们分析了手术适应症、骨愈合率、并发症及再次手术率。骨愈合率为86.7%，平均愈合时间为4.5个月。并发症发生率为55.7%。与内固定相关的并发症在所有并发症中占很大比例。再次手术率为22%。3%的病例进行了翻修关节融合术，1.5%的病例进行了截肢。该综述表明，髓内钉固定的胫距跟关节融合术骨愈合率相对较好，但并发症发生率较高。大多数并发症与内固定有关。文中讨论了减少这些并发症的建议策略。
