Giannini Sandro, Cadossi Matteo, Mazzotti Antonio, Ramponi Laura, Belvedere Claudio, Leardini Alberto
Professor, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
Surgeon, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
J Foot Ankle Surg. 2016 Nov-Dec;55(6):1271-1275. doi: 10.1053/j.jfas.2015.04.012. Epub 2015 Jul 29.
Professional athletes are often eager to resume sporting activities at preinjury levels. When facing the challenge of restoring joint function after a complex articular fracture, innovative solutions must be explored. We describe the results of what we believe to be the first custom-made talonavicular prosthesis implanted in a professional rock climber who had developed post-traumatic ankle and talonavicular arthritis as sequelae of a complex talar and navicular fracture. Using computed tomography scan reconstruction of the contralateral healthy ankle and direct metal laser sintering, a custom-made talonavicular prosthesis was obtained and implanted using an anteromedial approach. The patient was clinically and radiographically evaluated every 6 months after surgery for 30 months. A 3-dimensional videofluoroscopic analysis was performed to assess the range of motion about the prosthesis. At the last follow-up visit, the functional scores were excellent (Tegner activity scale score of 9 of 10), and he had completely resumed his sporting activity. The American Orthopaedic Foot and Ankle Society score had increased from 36 to 81 points, and no signs of radiolucency were observed on the radiographs. The 3-dimensional videofluoroscopic analysis showed 15° of dorsiflexion and 4° of plantar flexion at the ankle. A customized solution is an option when the patient's expectations are not likely to be met by standard treatment, such as arthrodesis. A custom-made talonavicular prosthesis can be an effective solution for complex ankle injury sequelae in patients demanding high functionality.
职业运动员往往急于恢复到受伤前的运动水平。在面对复杂关节骨折后恢复关节功能的挑战时，必须探索创新的解决方案。我们描述了我们认为首例为一名职业攀岩者植入定制距舟关节假体的结果，该患者因复杂的距骨和舟骨骨折后遗症而患上创伤后踝关节和距舟关节炎。通过对侧健康踝关节的计算机断层扫描重建和直接金属激光烧结，获得了定制的距舟关节假体，并采用前内侧入路进行植入。术后每6个月对患者进行临床和影像学评估，持续30个月。进行三维视频荧光透视分析以评估假体周围的活动范围。在最后一次随访时，功能评分优异（Tegner活动量表评分为10分中的9分），他已完全恢复运动。美国矫形足踝协会评分从36分提高到81分，X线片上未观察到透亮迹象。三维视频荧光透视分析显示踝关节背屈15°，跖屈4°。当标准治疗（如关节融合术）不太可能满足患者期望时，定制解决方案是一种选择。定制的距舟关节假体对于要求高功能的患者的复杂踝关节损伤后遗症可能是一种有效的解决方案。
