Kolodziej Lukas, Sadlik Boguslaw, Sokolowski Sebastian, Bohatyrewicz Andrzej
Orthopaedic, Traumatology and Orthopedic Oncology Clinic, Pomeranian Medical University, Szczecin, Poland.
Biological Joint Reconstruction Department, St. Luke's Hospital, Bielsko-Biala, Poland.
Open Orthop J. 2017 Feb 24;11:37-44. doi: 10.2174/1874325001711010037. eCollection 2017.
As orthopedic surgeons become skilled in ankle arthroscopy technique and evidence -based data is supporting its use, arthroscopic ankle arthrodesis (AAA) will likely continue to increase, but stabilization methods have not been described clearly. We present a technique for two parallel 7.3-mm headless compression screws fixation (HCSs) for AAA in cases of ankle arthritis with different etiology, both traumatic and non-traumatic, including neuromuscular and inflammatory patients.
We retrospectively verified 24 consecutive patients (25 ankles) who underwent AAA between 2011 and 2015. The average follow-up was 26 months (range 18 to 52 months). Arthrodesis was performed in 16 patients due to posttraumatic arthritis (in 5 as a sequela of pilon, 6 ankles, 3 tibia fractures, and 2 had arthritis due to chronic instability after lateral ligament injury), in 4 patients due to neuromuscular ankle joint deformities, and in 4 patients due to rheumatoid arthritis.
Fusion occurred in 23 joints (92%) over an average of 12 weeks (range 6 to 18 weeks). Ankle arthrodesis was not achieved in 2 joints (8%), both in post-pilon fracture patients. The correct foot alignment was not achieved in 4 feet (16%). None of the treated patients required hardware removal.
The presented technique was effective in achieving a high fusion rate in a variety of diseases, decreasing intra- and post-operative hardware complications while maintaining adequate bone stability.
随着骨科医生在踝关节镜技术方面日益熟练，且循证医学数据支持其应用，关节镜下踝关节融合术（AAA）的应用可能会持续增加，但稳定方法尚未得到清晰描述。我们介绍一种用于不同病因（包括创伤性和非创伤性，如神经肌肉性和炎性疾病）的踝关节关节炎患者进行AAA的双平行7.3毫米无头加压螺钉固定（HCSs）技术。
我们回顾性验证了2011年至2015年间连续接受AAA手术的24例患者（25个踝关节）。平均随访时间为26个月（范围18至52个月）。16例患者因创伤后关节炎接受融合术（其中5例为pilon骨折后遗症，6个踝关节，3例胫骨骨折，2例因外侧韧带损伤后慢性不稳定导致关节炎），4例患者因神经肌肉性踝关节畸形接受手术，4例患者因类风湿关节炎接受手术。
平均12周（范围6至18周）内，23个关节（92%）实现融合。2个关节（8%）未实现踝关节融合，均为pilon骨折后患者。4只脚（16%）未达到正确的足部对线。所有接受治疗的患者均无需取出内固定物。
所介绍的技术在多种疾病中有效实现了高融合率，减少了术中及术后的内固定并发症，同时维持了足够的骨稳定性。
