Lucas y Hernandez J, Laffenêtre O, Toullec E, Darcel V, Chauveaux D
Orthopédie-traumatologie Pr. Chauveaux, groupe hospitalier Pellegrin, place Amélie Raba-Léon, 33000 Bordeaux, France.
Orthopédie-traumatologie Pr. Chauveaux, groupe hospitalier Pellegrin, place Amélie Raba-Léon, 33000 Bordeaux, France.
Orthop Traumatol Surg Res. 2014 Dec;100(8):907-15. doi: 10.1016/j.otsr.2014.09.019. Epub 2014 Nov 13.
Despite good clinical results following total ankle replacement (TAR), the development of large periprosthetic cysts (>400 mm(2)) in the medium-term is a source of concern.
The primary objective of this study was to detect any large periprosthetic cysts in a cohort of AKILE™ patients using radiographs and CT scans, and then to compare these findings to published ones.
A total of 127 TAR procedures were performed between June 1995 and January 2012. We retrospectively reviewed 68 cases with the newest AKILE™ implant design that had a minimum follow-up of 36 months. The average follow-up was 81 ± 33 months; eight patients were lost to follow-up. The outcomes consisted of analyzing radiographs (A/P and lateral weight bearing views, Meary view and lateral views of flexion/extension) and helical CT scans, performing clinical evaluations (range of motion, AOFAS score, Foot Function Index, pain levels) and determining the survivorship of TAR implants.
TAR survival at 5 years was 79% for in situ implants and 62% for revision-free implants. The AOFAS score improved from 33.7 ± 14.7 to 77.1 ± 15.1 (out of 100) and the pain sub-score was 30.2 ± 9.7 (out of 40) at the last follow-up. The average ankle range of motion was 32.3° ± 12.7° on the radiographs. CT scan revealed Type A cysts (<200 mm(2)) under the talar implant in 52% of cases and in the tibia in 50% of cases; these cysts were smaller than 100 mm(2) in 80% of cases and had no effect on the implants. No periprosthetic cysts larger than 400 mm(2) in size were identified.
The medium-term functional results and survivorship are comparable to those reported for other TAR designs. The incidence of cysts was low overall and there were no large-diameter cysts, which should improve long-term survival. The implant's design and materials likely played a role in preserving the periprosthetic bone stock. The AKILE™ TAR has distinctive features related to the low rate of large periprosthetic cysts in the medium-term.
IV (retrospective case series).
尽管全踝关节置换术（TAR）取得了良好的临床效果，但中期出现的大型假体周围囊肿（>400 mm²）仍是一个令人担忧的问题。
本研究的主要目的是通过X线片和CT扫描检测一组使用AKILE™假体患者中的大型假体周围囊肿，然后将这些结果与已发表的结果进行比较。
1995年6月至2012年1月期间共进行了127例TAR手术。我们回顾性分析了68例采用最新AKILE™假体设计且随访至少36个月的病例。平均随访时间为81±33个月；8例患者失访。结果包括分析X线片（前后位和侧位负重位、Meary位以及屈伸侧位）和螺旋CT扫描、进行临床评估（活动范围、美国足踝外科协会（AOFAS）评分、足部功能指数、疼痛程度）以及确定TAR假体的生存率。
原位植入假体5年生存率为79%，初次植入且无需翻修的假体生存率为62%。最后一次随访时，AOFAS评分从33.7±14.7提高到77.1±15.1（满分100分），疼痛子评分为30.2±9.7（满分40分）。X线片显示平均踝关节活动范围为32.3°±12.7°。CT扫描显示，52%的病例距骨假体下方出现A型囊肿（<200 mm²），50%的病例胫骨假体下方出现A型囊肿；80%的囊肿小于100 mm²，且对假体无影响。未发现尺寸大于400 mm²的假体周围囊肿。
中期功能结果和生存率与其他TAR设计报告的结果相当。囊肿总体发生率较低，且无大直径囊肿，这应能提高长期生存率。假体的设计和材料可能在保留假体周围骨量方面发挥了作用。AKILE™ TAR在中期具有与大型假体周围囊肿发生率低相关的独特特征。
IV级（回顾性病例系列）。
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