Harvard Medical School , Boston, MA, USA.
Foot Ankle Int. 2011 Oct;32(10):986-93. doi: 10.3113/FAI.2011.0986.
Supramalleolar osteotomy using circular external fixation with six-axis deformity correction is a rarely reported treatment method particularly well-suited for complex multidimensional deformities of the adult ankle. The purpose of this study was to assess the accuracy of deformity correction and change in functional status using this technique.
We present a retrospective review of 52 patients who underwent supramalleolar osteotomy with application of the Taylor Spatial Frame (Smith & Nephew, Memphis, TN). Mean age was 44 (range, 18 to 79) years. The primary outcome was change in preoperative to postoperative distal tibial joint orientation angles. Coronal and sagittal plane joint orientation angles were measured for all 52 enrolled patients. The secondary outcome was change in AOFAS scores which were available for 31 patients.
Twenty-two patients had oblique plane deformities. The mean time in frame was 4 (range, 2 to 11) months, and patients were followed for a mean of 14 months after frame removal. All aggregate postoperative distal tibial angles underwent a significant improvement (p < 0.05) and were within 0 degrees to 4 degrees of normal in the various deformity groups. Average preoperative AOFAS score was 40 (range, 12 to 67) and average postoperative AOFAS score was 71 (range, 34 to 97; p < 0.001). Complications included two patients with nonunions at the osteotomy site that healed with further treatment. Three patients went on to have ankle fusion.
We feel that supramalleolar osteotomy using circular external fixation with six-axis deformity correction was an effective method for correction of distal tibial deformities in the adult population, particularly for those patients with complex oblique-plane deformities, associated rotational deformity, a compromised soft tissue envelope, or a prior history of infection.
使用带有六轴畸形矫正的环形外固定架进行踝上截骨术是一种很少报道的治疗方法，特别适合成人踝关节的复杂多维畸形。本研究旨在评估使用该技术矫正畸形和功能状态变化的准确性。
我们回顾性分析了 52 例接受泰勒空间框架（Smith & Nephew，Memphis，TN）应用的踝上截骨术患者。平均年龄为 44 岁（范围 18 至 79 岁）。主要结果是术前到术后远端胫骨关节定向角度的变化。对所有 52 名入组患者进行冠状面和矢状面关节定向角度测量。次要结果是 AOFAS 评分的变化，其中 31 例患者可获得该评分。
22 例患者存在斜平面畸形。平均外固定时间为 4 个月（范围 2 至 11 个月），在去除外固定器后平均随访 14 个月。所有综合术后远端胫骨角度均有显著改善（p < 0.05），且在各种畸形组中均在 0 度至 4 度正常范围内。平均术前 AOFAS 评分为 40 分（范围 12 至 67 分），平均术后 AOFAS 评分为 71 分（范围 34 至 97 分；p < 0.001）。并发症包括 2 例截骨处骨不连，经进一步治疗愈合。3 例患者行踝关节融合术。
我们认为，使用带有六轴畸形矫正的环形外固定架进行踝上截骨术是矫正成人胫骨远端畸形的有效方法，特别适用于那些存在复杂斜平面畸形、相关旋转畸形、软组织包绕不良或既往感染史的患者。
