Ahmad Jamal, Pedowitz David
Rothman Institute Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, Philadelphia, PA 19107, USA.
Foot Ankle Clin. 2012 Jun;17(2):309-22. doi: 10.1016/j.fcl.2012.03.008.
The traditional surgical treatment for adults with a rigid, arthritic flatfoot is a dual-incision triple arthrodesis. Over time, this procedure has proved to be reliable and reproducible in obtaining successful deformity correction through fusion and good clinical results. However, the traditional dual-incision triple arthrodesis is not without shortcomings. Early complications include lateral wound problems, malunion, and nonunion. Long-term follow-up of patients after a triple arthrodesis has shown that many develop adjacent joint arthritis at the ankle or midfoot. This particular problem should be considered an expected consequence, rather than a failure of the procedure. Although the indications for and surgical techniques used in triple arthrodesis have evolved and improved with time (predictably improving results in the intermediate term), the triple arthrodesis should be regarded as a salvage procedure. Certain measures can be taken by the surgeon to avoid some problems. If patients are at risk for lateral wound complications, the arthrodesis could be performed through a single medial incision. However, this can make some aspects of the CC fusion more difficult. Implants would have to be inserted percutaneously, which prevents the surgeon from using either staples or plates. If a patient were to need a lateral column lengthening through a CC distraction fusion, this would not be possible medially. If either the ST or CC joints have minimal degenerative changes, they could be spared through a double or modified double arthrodesis, respectively. Although these procedures that deviate from the traditional triple arthrodesis offer promise, further study is required to better define their role in treatment of the rigid, arthritic AAFD. Triple arthrodesis is, by no means, a simple surgery. It requires preoperative planning, meticulous preparation of bony surfaces, cognizance of hindfoot positioning, and rigidity of fixation. The procedure also requires enough experience on the part of the operating surgeon to anticipate postoperative problems and provide modifications in traditional technique for certain patients.
对于患有僵硬性、关节炎性扁平足的成年人，传统的外科治疗方法是双切口三关节融合术。随着时间的推移，该手术已被证明在通过融合获得成功的畸形矫正和良好的临床效果方面是可靠且可重复的。然而，传统的双切口三关节融合术并非没有缺点。早期并发症包括外侧伤口问题、畸形愈合和不愈合。对接受三关节融合术患者的长期随访表明，许多患者会在踝关节或中足出现相邻关节关节炎。这个特殊问题应被视为一种预期后果，而非手术失败。尽管随着时间的推移，三关节融合术的适应证和手术技术已经发展和改进（中期结果可预见地有所改善），但三关节融合术应被视为一种挽救性手术。外科医生可以采取某些措施来避免一些问题。如果患者有外侧伤口并发症的风险，关节融合术可以通过单一内侧切口进行。然而，这会使距下关节（CC）融合的某些方面更加困难。植入物必须经皮插入，这使得外科医生无法使用订书钉或钢板。如果患者需要通过CC撑开融合进行外侧柱延长，在内侧则无法做到。如果距舟（ST）关节或CC关节的退变变化最小，可分别通过双关节融合术或改良双关节融合术保留这些关节。尽管这些偏离传统三关节融合术的手术有前景，但需要进一步研究以更好地确定它们在治疗僵硬性、关节炎性成人获得性扁平足畸形（AAFD）中的作用。三关节融合术绝不是一个简单的手术。它需要术前规划、精心准备骨面、了解后足位置以及固定的牢固性。该手术还需要手术医生有足够的经验来预见术后问题，并针对某些患者对传统技术进行改进。
