LaPorta Guido A, Nasser Ellianne M, Mulhern Jennifer L
Chief, Podiatric Medicine and Surgery, and Residency Director, Geisinger Community Medical Center, Scranton, PA; and Fellowship Director, Limb Salvage and Reconstructive Surgery Fellowship Program, Northeast Regional Foot and Ankle Institute, Dunmore, PA.
Fellow, Limb Salvage and Reconstructive Surgery Fellowship Program, Northeast Regional Foot and Ankle Institute, Dunmore, PA.
J Foot Ankle Surg. 2014 Nov-Dec;53(6):774-86. doi: 10.1053/j.jfas.2014.06.027. Epub 2014 Aug 22.
The present case series outlines the history and surgical treatment of 6 patients who underwent tibiocalcaneal arthrodesis from April 2002 to May 2012, all with external fixation as the primary or secondary fixation. Surgical intervention was performed by the same surgeon at the same facility. The indication for surgery was a nonbraceable Charcot deformity in 5 (83.3%) patients and bone and soft tissue infection complicating previous intramedullary hindfoot fusion in 1 (16.7%) patient. Talectomy was performed in 2 (33.3%) patients secondary to widespread osteomyelitis of the talus and in 4 (66.7%) patients secondary to avascular necrosis and/or disintegration and fragmentation of the remaining talus. The postoperative complications have been discussed in detail and their management outlined. At the most recent follow-up visit, all patients were independently ambulating on a braceable limb with or without the use of an assistive device. In conclusion, tibiocalcaneal arthrodesis is a reasonable option for limb salvage to produce community ambulators in the high-risk population. We emphasize that although multiple fixation options are available for tibiocalcaneal arthrodesis, a combination of internal and external fixation is vital to its success.
本病例系列概述了2002年4月至2012年5月期间接受胫跟关节融合术的6例患者的病史及手术治疗情况，所有患者均采用外固定作为主要或辅助固定方式。手术由同一位外科医生在同一机构进行。手术指征为5例（83.3%）患者存在不可用支具矫正的夏科氏畸形，1例（16.7%）患者因既往后足髓内融合术后出现骨与软组织感染。2例（33.3%）患者因距骨广泛骨髓炎而进行了距骨切除术，4例（66.7%）患者因剩余距骨出现缺血性坏死和/或崩解碎裂而进行了距骨切除术。已详细讨论了术后并发症并概述了其处理方法。在最近一次随访时，所有患者均可独立行走，患侧肢体可使用或不使用辅助装置。总之，胫跟关节融合术是挽救高危人群肢体、使其能够在社区行走的合理选择。我们强调，尽管胫跟关节融合术有多种固定选择，但内固定与外固定相结合对其成功至关重要。
