Tan Bryan Yijia, Ng Sean Yung Chuan, Chong Keen Wai, Rikhraj Inderjeet Singh
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
J Orthop Surg (Hong Kong). 2013 Apr;21(1):51-4. doi: 10.1177/230949901302100114.
To report 18 patients who underwent tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail or cannulated screws.
10 men and 8 women (19 ankles) aged 36 to 70 (mean, 52) years underwent tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail (n=13) or cannulated screws (n=6). Indications for arthrodesis were severe cavovarus deformity secondary to polio or charcot-marie-tooth disease (n=7), severe osteoarthritis in the ankle and subtalar joints (n=6), Charcot joint deformity (n=3), failed fusion procedures (n=2), and foot drop secondary to T12 tumour surgery (n=1). The visual analogue score (VAS) for pain was assessed, as were the American Orthopaedic Foot and Ankle Society (AOFAS) scores (for subjective and objective pain, function, and stability of the ankle), short form 36 (SF-36), and patient expectation and satisfaction scores.
The mean follow-up period was 35.6 (range, 11-144) months. 13 of 18 patients returned for assessment of scores. 18 of the 19 ankles achieved fusion after a mean period of 5.9 (range, 3-11) months. The mean VAS scores for pain, AOFAS scores, and SF-36 scores all improved. 11 patients had good-to-excellent satisfaction and expectation scores. Two patients had severe wound infections and underwent implant removal (after bone union), debridement, and intravenous antibiotic therapy. Two other patients had superficial wound infections. One patient with retrograde intramedullary nailing had a pseudoarthrosis and underwent implant removal, redebridement, re-autografting, and cannulated screw fixation. Fusion was achieved subsequently.
Tibiotalocalcaneal arthrodesis improved the pain score and quality of life, despite a high risk of complications.
报告18例行经跟骨逆行髓内钉或空心螺钉胫距跟关节融合术的患者。
10名男性和8名女性（共19例踝关节），年龄36至70岁（平均52岁），接受了经跟骨逆行髓内钉（n = 13）或空心螺钉（n = 6）的胫距跟关节融合术。关节融合术的适应证包括继发于小儿麻痹症或遗传性运动感觉神经病的严重高弓内翻畸形（n = 7）、踝关节和距下关节的严重骨关节炎（n = 6）、夏科关节畸形（n = 3）、融合手术失败（n = 2）以及T12肿瘤手术后的足下垂（n = 1）。评估了疼痛的视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）评分（用于评估踝关节主观和客观疼痛、功能及稳定性）、简明健康状况调查问卷（SF - 36）以及患者期望和满意度评分。
平均随访期为35.6（范围11 - 144）个月。18例患者中有13例返回进行评分评估。19例踝关节中有18例在平均5.9（范围3 - 11）个月后实现融合。疼痛的平均VAS评分、AOFAS评分和SF - 36评分均有所改善。11例患者的满意度和期望评分良好至优秀。2例患者发生严重伤口感染，接受了内植物取出（骨愈合后）、清创和静脉抗生素治疗。另外2例患者发生表浅伤口感染。1例行经跟骨逆行髓内钉固定的患者出现假关节，接受了内植物取出、再次清创、再次自体骨移植和空心螺钉固定。随后实现融合。
尽管并发症风险较高，但胫距跟关节融合术改善了疼痛评分和生活质量。
