Department of Orthopaedics, UNC School of Medicine, CB 7055, Chapel Hill, NC 27599-7055. E-mail address:
Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 0102x JPP, Iowa City, IA 52242-1088.
J Bone Joint Surg Am. 2014 Mar 5;96(5):395-402. doi: 10.2106/JBJS.M.01008.
Despite the use of contemporary total ankle arthroplasty implant designs, clinical outcomes of total ankle arthroplasty continue to lag behind those of other joint replacement procedures. Disruption of the extraosseous talar blood supply at the time of ankle replacement may be a factor contributing to talar component subsidence-a common mechanism of early failure following ankle replacement. We evaluated the risk of injury to specific extraosseous arteries supplying the talus associated with specific total ankle arthroplasty implants.
Sixteen fresh-frozen through-knee cadaveric specimens were injected with latex and barium sulfate distal to the popliteal trifurcation to visualize the arteries. Four specimens each were prepared for implantation of four contemporary total ankle arthroplasty systems: Scandinavian Total Ankle Replacement (STAR), INBONE II, Salto Talaris, and Trabecular Metal Total Ankle (TMTA). Postoperative computed tomography scans and 6% sodium hypochlorite chemical debridement were used to examine, measure, and document the proximity of the total ankle arthroplasty instrumentation to the extraosseous talar blood supply.
All four implant types subjected the extraosseous talar blood supply to the risk of injury. The INBONE subtalar drill hole directly transected the artery of the tarsal canal in three of four specimens. The lateral approach for the TMTA transected the first perforator of the peroneal artery in two of four specimens. The STAR caused medial injury to the deltoid branches in all four specimens, whereas the other three systems did not directly affect this supply (p < 0.005). The Salto Talaris and STAR implants caused injury to the artery of the tarsal canal in one of four specimens.
All four total ankle arthroplasty systems tested posed a risk of injury to the extraosseous talar blood supply, but the risks of injury to specific arteries were higher for specific implants.
尽管采用了现代全踝关节置换术植入物设计，但全踝关节置换术的临床效果仍落后于其他关节置换术。踝关节置换时距骨外骨血供中断可能是导致距骨组件下沉的一个因素-这是踝关节置换后早期失败的常见机制。我们评估了与特定全踝关节置换植入物相关的特定距骨外动脉损伤的风险。
将乳胶和硫酸钡注射到膝关节以下的 16 个冷冻尸体标本中，以可视化动脉。每个标本各准备四个现代全踝关节置换系统的植入物：Scandinavian Total Ankle Replacement（STAR），INBONE II，Salto Talaris 和 Trabecular Metal Total Ankle（TMTA）。术后计算机断层扫描和 6％次氯酸钠化学清创术用于检查、测量和记录全踝关节置换器械与距骨外血供的接近程度。
所有四种植入物类型都使距骨外血供面临受伤的风险。在四个标本中的三个中，INBONE 距下钻孔直接横断了跗管动脉。TMTA 的外侧入路在四个标本中的两个中横断了腓动脉的第一穿支。STAR 导致四个标本中的所有四个三角支都受到了内侧损伤，而其他三个系统则没有直接影响到这一供应（p<0.005）。Salto Talaris 和 STAR 植入物在四个标本中的一个中导致跗管动脉受伤。
所有四种测试的全踝关节置换系统都存在距骨外血供损伤的风险，但特定植入物对特定动脉损伤的风险更高。
