Nguyen Mai P, Pedersen Douglas R, Gao Yubo, Saltzman Charles L, Amendola Annunziato
Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.P. Nguyen:
Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address:
J Bone Joint Surg Am. 2015 Apr 1;97(7):590-6. doi: 10.2106/JBJS.N.00901.
Treatment of end-stage ankle osteoarthritis remains challenging, especially in young patients. Initial reports have shown early benefits of joint distraction for the treatment of ankle osteoarthritis. We report the five to ten-year results of a previously described patient cohort following ankle distraction surgery.
All thirty-six patients who had undergone ankle distraction surgery between December 2002 and October 2006 were contacted. Patients were evaluated by a clinical investigator and completed the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) surveys. Radiographs as well as computed tomography and magnetic resonance imaging scans of the ankles were obtained at the follow-up visits.
Twenty-nine patients (81%) were followed for a minimum of five years (mean and standard deviation, 8.3 ± 2.2 years). Sixteen (55%) of the twenty-nine patients still had the native ankle joint whereas thirteen patients (45%) had undergone either ankle arthrodesis or total ankle arthroplasty. Positive predictors of ankle survival included a better AOS score at two years (hazard ratio [HR] = 0.048, 95% confidence interval [CI] = 0.0028 to 0.84, p = 0.04), older age at surgery (HR = 0.91, 95% CI = 0.83 to 0.99, p = 0.04), and fixed distraction (HR = 0.094, 95% CI = 0.017 to 0.525, p < 0.01). Radiographs and advanced imaging revealed progression of ankle osteoarthritis at the time of final follow-up.
Ankle function following joint distraction declines over time. Patients should be well informed of the commitment that they must make during the treatment period as well as the long-term results after surgery.
终末期踝关节骨关节炎的治疗仍然具有挑战性，尤其是在年轻患者中。初步报告显示关节撑开术治疗踝关节骨关节炎有早期疗效。我们报告了先前描述的一组患者在踝关节撑开手术后五至十年的结果。
联系了2002年12月至2006年10月期间接受踝关节撑开手术的所有36名患者。由一名临床研究人员对患者进行评估，并完成踝关节骨关节炎量表（AOS）和简明健康状况调查问卷（SF-36）。在随访时获取踝关节的X线片以及计算机断层扫描和磁共振成像扫描。
29名患者（81%）接受了至少五年的随访（平均8.3±2.2年）。29名患者中有16名（55%）仍保留原生踝关节，而13名患者（45%）接受了踝关节融合术或全踝关节置换术。踝关节存活的阳性预测因素包括两年时更好的AOS评分（风险比[HR]=0.048，95%置信区间[CI]=0.0028至0.84，p=0.04）、手术时年龄较大（HR=0.91，95%CI=0.83至0.99，p=0.04）以及固定撑开（HR=0.094，95%CI=0.017至0.525，p<0.01）。在最后随访时，X线片和高级成像显示踝关节骨关节炎有所进展。
关节撑开术后踝关节功能会随着时间推移而下降。应让患者充分了解他们在治疗期间必须做出的努力以及手术后的长期结果。
