Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
J Bone Joint Surg Am. 2016 Apr 20;98(8):636-46. doi: 10.2106/JBJS.15.00702.
Subtalar arthrodesis is a standard treatment for subtalar arthritis. Both open and arthroscopic techniques have been described and are commonly used. The cases of a consecutive series of 121 patients treated with either open or posterior arthroscopic techniques are presented with functional outcomes and complications.
A retrospective chart review with prospectively collected data was performed for 121 consecutive patients (129 feet) who underwent subtalar arthrodesis with open (60 feet in 57 patients) or arthroscopic (69 feet in 64 patients) techniques between 2001 and 2014. The technique was selected on the basis of the deformity and surgeon preference. The primary outcomes were the visual analog scale (VAS) for pain, Short Form (SF)-36, Foot Function Index (FFI), and Angus and Cowell rating scores. Secondary outcomes included hindfoot alignment, operative time, length of hospital stay, fusion rate, time to return to work, ability to perform sports and activities of daily living, and complications.
Both groups demonstrated significant improvement in VAS, SF-36, FFI, and Angus and Cowell rating scale scores. The mean operative time, VAS score, Angus and Cowell rating score, and coronal plane hindfoot alignment were similar between the groups. There were no significant differences within the groups with respect to union rate and time to union among the various sizes of screws and types of bone graft. Sural nerve complications and a painful surgical scar were more frequent in the open group, whereas hardware-related symptoms were more frequent in the arthroscopically treated group.
Subtalar arthrodesis performed with open and arthroscopically assisted techniques demonstrated significant improvement in terms of pain and function as measured with the VAS, FFI, and SF-36. While the time to union and to return to work, activities of daily living, and sports activities were significantly shorter for the arthroscopic arthrodesis group, the union rates and complications overall were not significantly different.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
距下关节融合术是治疗距下关节炎的标准方法。已经描述并广泛应用了开放式和关节镜式技术。本文介绍了连续系列的 121 例患者，他们分别接受了开放式或后关节镜式技术治疗，评估了他们的功能结果和并发症。
对 2001 年至 2014 年间接受开放式（57 例患者的 60 足）或关节镜式（64 例患者的 69 足）距下关节融合术的 121 例连续患者（129 足）进行了回顾性图表分析和前瞻性数据收集。技术的选择基于畸形和外科医生的偏好。主要结果是视觉模拟量表（VAS）疼痛评分、简短表格（SF）-36、足功能指数（FFI）和 Angus 和 Cowell 评分。次要结果包括后足对线、手术时间、住院时间、融合率、重返工作时间、进行体育活动和日常生活活动的能力以及并发症。
两组 VAS、SF-36、FFI 和 Angus 和 Cowell 评分均显著改善。两组的平均手术时间、VAS 评分、Angus 和 Cowell 评分和冠状面后足对线相似。在各种大小的螺钉和类型的植骨中，各组之间的融合率和融合时间没有显著差异。开放式组中更常见的是腓肠神经并发症和疼痛的手术疤痕，而关节镜治疗组中更常见的是与硬件相关的症状。
开放式和关节镜辅助技术进行的距下关节融合术在 VAS、FFI 和 SF-36 测量的疼痛和功能方面均显著改善。虽然关节镜融合术组的融合时间和重返工作时间、日常生活活动和体育活动时间明显缩短，但总体融合率和并发症无显著差异。
治疗性 III 级。有关完整的证据水平说明，请参见作者说明。
