Frigg Arno, Maquieira Gerardo, Horisberger Monika
Orthopaedic Department, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Foot and Ankle Centre Hirslanden, Witellikerstrasse 40, 8032, Zürich, Switzerland.
Int Orthop. 2017 Aug;41(8):1585-1592. doi: 10.1007/s00264-017-3489-z. Epub 2017 May 8.
The resection of os trigonum or posterior talar process as treatment for posterior ankle impingement is an established operation. However, the authors encountered several painful stress reactions in the posterior subtalar joint during follow-up resulting in persisting incapacity to do sports.
From March 2011 to July 2015, 29 patients with 30 feet were operated (22 endoscopic, 8 open resections). Average follow-up time was 43 ± 13 months. Complications were grouped into "none", "temporary disadvantage" and "permanent damage". The following radiographic parameters were measured: (1) length of posterior talar process or os trigonum, (2) length of the uncovered calcaneal joint surface after resection, (3) amount of resection.
The rate of permanent damage was 13.3% (4 of 30 feet), and all four of these patients developed a painful stress reaction in the posterior subtalar joint. One temporary disadvantage (persistent pain for three months) was found. All patients with major complications showed retrospectively what we call the "risk configuration" -the radius of the talus ending within the subtalar joint. The length of the uncovered calcaneal joint surface was therefore significantly larger (6.4 mm ± 3.33) in feet with permanent damage than in feet without (1.06 mm ± 2.15, P < 0.001).
The resection of os trigonum or posterior talar process has a complication rate of 13.3% with persisting inability to do sports due to painful stress reaction in the posterior subtalar joint. The only risk factor found was the "risk configuration". In such cases, the resection has to be made not anterior into the subtalar joint and patients have to be informed about this possible complication.
Retrospective case series; Evidence Level 4.
切除距骨三角骨或后距骨突作为治疗后踝撞击症的一种手术方法已得到确立。然而，作者在随访过程中发现数例患者距下后关节出现疼痛性应力反应，导致持续无法进行体育运动。
2011年3月至2015年7月，对29例患者的30只足进行了手术（22例为关节镜下手术，8例为开放切除术）。平均随访时间为43±13个月。并发症分为“无”、“暂时不利影响”和“永久性损伤”。测量了以下影像学参数：（1）后距骨突或距骨三角骨的长度；（2）切除术后未覆盖的跟骨关节面长度；（3）切除量。
永久性损伤发生率为13.3%（30只足中的4只），这4例患者均在距下后关节出现疼痛性应力反应。发现1例有暂时不利影响（持续疼痛3个月）。回顾性分析发现，所有出现严重并发症的患者均呈现我们所称的“风险构型”——距骨半径止于距下关节内。因此，发生永久性损伤的足的未覆盖跟骨关节面长度（6.4mm±3.33）显著大于未发生永久性损伤的足（1.06mm±2.15，P<0.001）。
切除距骨三角骨或后距骨突的并发症发生率为13.3%，因距下后关节疼痛性应力反应导致持续无法进行体育运动。发现的唯一风险因素是“风险构型”。在这种情况下，切除术不应进入距下关节前方，并且必须告知患者这种可能的并发症。
回顾性病例系列；证据等级4。
