Chalayon Ornusa, Wang Bibo, Blankenhorn Brad, Jackson J Benjamin, Beals Timothy, Nickisch Florian, Saltzman Charles L
University Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA.
University Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA Shanghai Institute of Traumatology and Orthopaedics, Orthopaedic Department, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Foot Ankle Int. 2015 Oct;36(10):1170-9. doi: 10.1177/1071100715587045. Epub 2015 May 20.
The objective of this study was to identify factors influencing operative outcomes in straightforward, uncomplicated open ankle fusions.
We reviewed all primary open ankle fusions conducted at 1 institution over an 11-year period to identify straightforward, uncomplicated open ankle fusions. Inclusion required a minimum of 6 months follow-up. Patients were excluded for neuropathic arthropathy, insensate limb, failed total ankle replacement, simultaneous arthrodesis of the subtalar joint, or fusions performed within 1 year of injury to salvage failed fixation and painful function due to (1) open fractures, (2) segmental bone loss greater than 1 cm, (3) infection, or (4) talar body fractures. The primary outcome variable was radiographic union at 6 months. Other operative complications were analyzed as secondary outcomes. Five hundred twenty-eight ankle fusion surgeries were performed on 440 patients at 1 institution during the study period. Two hundred fifteen surgeries met inclusion/exclusion eligibility criteria for uncomplicated open ankle fusions.
The overall union rate was 91%. In this cohort of uncomplicated open ankle fusions, bivariate analysis over a broad range of potential factors and further focused multivariate analysis found that nonunion was more than 3 times more likely to occur after previous subtalar fusion, and 2 times more likely to occur in patients with preoperative varus ankle alignment. The rate of reoperation was 19%, with nonunion revision as the leading reason, followed by hardware removal and incision and drainage for presumed infection. Diabetes was not a significant risk factor of either deep or superficial infection.
Open ankle fusion failed in 9% of uncomplicated ankles with arthritis. Patients who had an open ankle fusion done after previous subtalar joint fusion, as well as those who had preoperative varus ankle alignment, had a significantly higher rate of nonunion.
Level III, retrospective comparative study.
本研究的目的是确定影响单纯、无并发症的开放性踝关节融合术手术效果的因素。
我们回顾了某一机构在11年期间进行的所有初次开放性踝关节融合术，以确定单纯、无并发症的开放性踝关节融合术。纳入标准要求至少随访6个月。因神经性关节病、肢体感觉丧失、全踝关节置换失败、距下关节同期融合术，或因（1）开放性骨折、（2）节段性骨缺损大于1cm、（3）感染或（4）距骨体骨折导致内固定失败和疼痛性功能障碍而在受伤1年内进行的融合术患者被排除。主要结局变量是6个月时的影像学骨愈合。其他手术并发症作为次要结局进行分析。在研究期间，某一机构对440例患者进行了528例踝关节融合手术。215例手术符合单纯性开放性踝关节融合术的纳入/排除标准。
总体骨愈合率为91%。在这组无并发症的开放性踝关节融合术中，对广泛的潜在因素进行双变量分析，并进一步进行重点多变量分析发现，既往距下关节融合术后骨不愈合的发生率高出3倍多，术前踝关节内翻的患者骨不愈合发生率高出2倍。再次手术率为19%，以骨不愈合翻修术为主要原因，其次是取出内固定物以及因疑似感染进行切开引流。糖尿病不是深部或浅表感染的显著危险因素。
9%的无并发症的关节炎性踝关节开放性融合术失败。既往距下关节融合术后进行开放性踝关节融合术的患者，以及术前踝关节内翻的患者，骨不愈合发生率显著更高。
III级，回顾性比较研究。
