Hyer Christopher F, Galli Melissa M, Scott Ryan T, Bussewitz Bradly, Berlet Gregory C
Attending Physician, Orthopedic Foot and Ankle Center, Westerville, OH.
Resident, Ohio State University Medical Center, Columbus, OH.
J Foot Ankle Surg. 2014 Jan-Feb;53(1):55-8. doi: 10.1053/j.jfas.2013.02.018. Epub 2013 Jul 31.
The medial double arthrodesis, comprised of subtalar and talonavicular joint fusions, has become a popular way to correct hindfoot deformity. There is potential concern for an increase in ankle valgus postoperatively owing to extended medial dissection and possible disruption of the deltoid ligament. Although this approach is often used to correct a valgus hindfoot, little attention has been paid to date on this procedure's effect on the tibiotalar joint. Although the medial double arthrodesis has been shown to produce reproducible outcomes without violating the lateral hindfoot structures, our hypothesis was that this approach would increase the ankle valgus deformity compared with its triple counterpart. The primary goal of the present retrospective study was to identify the frequency and severity of ankle valgus after the medial double arthrodesis compared with the triple arthrodesis. A total of 77 patients (78 feet) met our inclusion criteria. Their mean age was 61.3 ± 10.7 (range 27 to 79) years, and the follow-up period was 15.7 ± 9.9 (range 6 to 46) months. There were 16 and 61 patients (62 feet) in the medial double and triple arthrodesis groups, respectively. Overall, the preoperative ankle valgus was 1.24° ± 2.02° (range 0° to 6°), and there was no statistical difference of preoperative ankle valgus noted between groups (p = .060). Collectively, postoperative ankle valgus was 3.01° ± 3.54° (0° to 17°) with an increase in ankle valgus in 4 of 16 medial double and 34 of 62 triple arthrodesis patients. With a mean follow-up of 8.75 ± 4.02 (6 to 21) months, the medial double arthrodesis cohort's ankle valgus increased from 0.5° ± 1.55° (0° to 6°) to 1.5° ± 3.14° (1° to 10°) postoperatively. The triple arthrodesis group had a mean follow-up 17.53 ± 10.17 (6 to 46) months and ankle valgus increased from 1.44° ± 2.09° (0 to 6°) to 3.40° ± 3.56° (0° to 17°). Postoperative ankle valgus was statistically significant between groups (U = 303.50, p = .013). The odds of having an increase in the valgus ankle angle for patients in the triple group was 3.64 times that for patients in the double group, while holding all other variables in the model constant.
内侧双关节固定术，包括距下关节和距舟关节融合，已成为矫正后足畸形的常用方法。由于内侧广泛解剖以及三角韧带可能受损，术后存在踝关节外翻增加的潜在担忧。尽管这种方法常用于矫正后足外翻，但迄今为止，该手术对胫距关节的影响鲜受关注。虽然内侧双关节固定术已被证明在不破坏后足外侧结构的情况下能产生可重复的结果，但我们的假设是，与三联关节固定术相比，这种方法会增加踝关节外翻畸形。本回顾性研究的主要目的是确定内侧双关节固定术与三联关节固定术后踝关节外翻的发生率和严重程度。共有77例患者（78足）符合纳入标准。他们的平均年龄为61.3±10.7（27至79岁）岁，随访期为15.7±9.9（6至46个月）。内侧双关节固定术组和三联关节固定术组分别有16例和61例患者（62足）。总体而言，术前踝关节外翻为1.24°±2.02°（0°至6°），两组术前踝关节外翻无统计学差异（p = 0.060）。总体而言，术后踝关节外翻为3.01°±3.54°（0°至17°），16例内侧双关节固定术患者中有4例、62例三联关节固定术患者中有34例踝关节外翻增加。平均随访8.75±4.02（6至21）个月，内侧双关节固定术队列的踝关节外翻从术前的0.5°±1.55°（0°至6°）增加到术后的1.5°±3.14°（1°至10°）。三联关节固定术组平均随访17.53±10.17（6至46）个月，踝关节外翻从1.44°±2.09°（0至6°）增加到3.40°±3.56°（0°至17°）。两组术后踝关节外翻有统计学差异（U = 303.50，p = 0.013）。在模型中保持所有其他变量不变的情况下，三联组患者踝关节外翻角度增加的几率是双关节组患者的3.64倍。
