全踝关节置换术时同时进行小腿三头肌延长对术后结果的影响。

The influence of concomitant triceps surae lengthening at the time of total ankle arthroplasty on postoperative outcomes.

作者信息

Queen Robin M, Grier A Jordan, Butler Robert J, Nunley James A, Easley Mark E, Adams Samuel B, DeOrio James K

机构信息

Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA Michael W. Krzyzewski Human Performance Laboratory, Duke University, Durham, NC, USA

Michael W. Krzyzewski Human Performance Laboratory, Duke University, Durham, NC, USA.

出版信息

Foot Ankle Int. 2014 Sep;35(9):863-70. doi: 10.1177/1071100714539662. Epub 2014 Jun 18.

DOI:10.1177/1071100714539662

PMID:24942617

Abstract

BACKGROUND

Concomitant procedures are being performed with total ankle replacement (TAR) to improve alignment, function, and mobility. The purpose of this study was to examine the differences in outcomes between patients who had a concomitant triceps surae lengthening (gastrocnemius recession [GSR] or triple hemisection [TAL]) versus a group that underwent TAR alone preoperatively and 1 year after TAR.

METHODS

For this prospective, nonrandomized study, 229 patients (37 GSR, 22 TAL, and 170 TAR alone) were examined. Patient-reported outcomes, physical performance, and lower extremity gait mechanics were completed preoperatively and 1 year postoperatively. A series of repeated measures ANOVAs were used to determine significant differences (P < .05), and Tukey's post hoc testing was used to follow any significant ANOVA results.

RESULTS

No difference existed in BMI, age, gender, or dorsiflexion (DF) angle at heel strike between the triceps surae lengthening groups or between preoperative and 1 year following TAR. Walking speed, the physical performance measures, the AOFAS Hindfoot Score, SF-36, peak plantar flexion angle, and the peak plantar flexion moment were significantly improved (P < .001) postoperatively with no differences between the triceps surae lengthening groups. The peak DF angle (P = .006) and the ankle range of motion (P = .014) demonstrated a greater improvement from preoperative to 1 year postoperatively in the triceps surae lengthening groups in comparison to the TAR alone group.

CONCLUSION

Significant improvements existed between preoperative and 1 year postoperatively for most of the variables of interest independent of the triceps surae lengthening group. This study demonstrated that the use of a concomitant triceps surae lengthening procedure (GSR or TAL) resulted in equivalent outcomes when compared with a group undergoing TAR alone.

LEVEL OF EVIDENCE

Level II, prospective comparative study.

摘要

背景

全踝关节置换术（TAR）常需同时进行其他手术以改善对线、功能和活动度。本研究旨在探讨接受三头肌延长术（腓肠肌松解术[GSR]或三联半切术[TAL]）的患者与术前及TAR术后1年单纯接受TAR的患者在结局上的差异。

方法

在这项前瞻性、非随机研究中，对229例患者（37例行GSR，22例行TAL，170例单纯行TAR）进行了检查。术前及术后1年完成患者报告结局、身体功能和下肢步态力学评估。采用一系列重复测量方差分析来确定显著差异（P <.05），并使用Tukey事后检验追踪任何显著的方差分析结果。

结果

三头肌延长术组之间或TAR术前与术后1年之间，在体重指数、年龄、性别或足跟触地时的背屈（DF）角度方面均无差异。术后步行速度、身体功能指标、美国足踝外科协会（AOFAS）后足评分、SF-36、峰值跖屈角度和峰值跖屈力矩均有显著改善（P <.001），三头肌延长术组之间无差异。与单纯TAR组相比，三头肌延长术组从术前到术后1年的峰值DF角度（P =.006）和踝关节活动范围（P =.014）改善更大。