Hyer Christopher F, Cheney Nick
Attending Physician, Orthopedic Foot and Ankle Center, Westerville, OH.
J Foot Ankle Surg. 2013 Nov-Dec;52(6):724-7. doi: 10.1053/j.jfas.2013.06.018. Epub 2013 Sep 7.
During the past 15 years, tibiotalocalcaneal nail arthrodesis has become an established procedure for the treatment of specific disorders of the hindfoot and ankle. However, controversy exists regarding the proper starting point for obtaining and maintaining the correct hindfoot position to allow successful fusion. One of the challenges with this procedure is aligning the tibial canal with the central talus and calcaneus for placement of the intramedullary nail. We performed a cadaver study to evaluate the radiographic and anatomic position of the tibial canal and the central talus as it relates to placement of a retrograde tibiotalocalcaneal nail. In our subjects, guide wires directed in an antegrade fashion down the tibial canal were more likely to enter lateral to the midline of the talus and miss the calcaneal body medially. These data have revealed a mismatch among the central axis of the tibia, talus, and calcaneus. Surgeons must pay careful attention to wire placement across these 3 bone segments during retrograde tibiotalocalcaneal nailing.
在过去15年中，胫距跟骨钉关节融合术已成为治疗后足和踝关节特定疾病的既定手术方法。然而，对于获得并维持正确的后足位置以实现成功融合的合适起始点存在争议。该手术的挑战之一是使胫骨髓腔与距骨中心和跟骨对齐，以便置入髓内钉。我们进行了一项尸体研究，以评估胫骨髓腔与距骨中心的影像学和解剖学位置，及其与逆行胫距跟骨钉置入的关系。在我们的研究对象中，沿胫骨髓腔顺行插入的导针更有可能进入距骨中线外侧，而内侧错过跟骨体。这些数据揭示了胫骨、距骨和跟骨中心轴之间的不匹配。在逆行胫距跟骨钉固定术中，外科医生必须在这三个骨段上仔细注意导针的放置。
