Brkljac M, Shah S, Hay C, Rodriguez-Merchan E C
Manchester Royal Infirmary, University of Manchester, Manchester, UK.
Department of Orthopaedic Surgery, Manchester Royal Infirmary, Manchester, UK.
Haemophilia. 2016 Mar;22(2):e87-e98. doi: 10.1111/hae.12863.
Haemophilic arthropathy of the ankle is rare disorder caused by recurrent haemarthorses beginning in early adulthood.
Our aim was to evaluate the fusion rate of various techniques of hindfoot fusion using internal fixation for the treatment of haemophilic arthropathy of the hindfoot.
We have evaluated the fusion rate of various techniques of hindfoot (tibiotalar and subtalar joints) fusion for the treatment of haemophilic arthropathy of the hindfoot. Twenty-eight patients underwent a total of 41 procedures. Thirty-four ankle (tibiotalar) fusions were performed, seven were done arthroscopically, six using a minimal access approach and 21 with an open approach. There were two isolated subtalar fusions, three combined tibiotalar and subtalar fusions, one of which included a talonavicular fusion at the second operation. There was one peritalar ankle fusion (tibiotalar, subtalar and talonavicular). The mean age at operation was 40.3 years (SD, 12.3; range, 18.7-65.7 years). The mean time to last follow-up was 77 months (SD, 50.4; range, 7-190).
The overall non-union rate was 9.7%. All non-unions occurred in tibiotalar fusions (there were no non-unions in cases of subtalar or talonavicular fusion). A single deep infection (2.4%) occurred in an arthroscopically fused ankle. The revision rate was 4.8% (2 cases) and was carried out for non-unions. Both revisions were successful.
Hindfoot arthrodesis in patients with haemophilic ankle arthropathy provides a high fusion rate with few complications. Arthroscopic tibiotalar fusion did not result in shorter hospital stays. Revision surgery for the haemophilic hindfoot is successful, and fusion of the entire hindfoot can be achieved without complications.
踝关节血友病性关节病是一种罕见疾病，由成年早期开始的反复关节积血引起。
我们的目的是评估使用内固定进行后足融合的各种技术对后足血友病性关节病的融合率。
我们评估了后足（胫距关节和距下关节）融合的各种技术对后足血友病性关节病的融合率。28例患者共接受了41次手术。进行了34例踝关节（胫距关节）融合，其中7例通过关节镜进行，6例采用微创入路，21例采用开放入路。有2例孤立的距下关节融合，3例胫距关节和距下关节联合融合，其中1例在第二次手术时包括舟距关节融合。有1例距周踝关节融合（胫距关节、距下关节和舟距关节）。手术时的平均年龄为40.3岁（标准差12.3；范围18.7 - 65.7岁）。最后一次随访的平均时间为77个月（标准差50.4；范围7 - 190）。
总体不愈合率为9.7%。所有不愈合均发生在胫距关节融合中（距下关节或舟距关节融合病例中无不愈合）。1例关节镜融合的踝关节发生了1例深部感染（2.4%）。翻修率为4.8%（2例），均因不愈合而进行。两次翻修均成功。
血友病性踝关节病患者的后足关节融合术融合率高且并发症少。关节镜下胫距关节融合并未缩短住院时间。血友病性后足的翻修手术成功，可实现整个后足的融合且无并发症。
