Klerken Tina, Kosse Nienke M, Aarts Chris A M, Louwerens Jan Willem K
Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands.
Sint Maartenskliniek Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
Foot Ankle Surg. 2019 Apr;25(2):247-250. doi: 10.1016/j.fas.2017.11.003. Epub 2017 Nov 29.
Pain, deformity and instability are the main reasons for fusion of the tarsal joints, a triple arthrodesis. The short and midterm results show that mobility, function and satisfaction increase postoperatively. However, osteoarthritis (OA) of the adjacent ankle joint is described as a long-term complication. Alignment of the foot could be an influencing factor. The aim of this study was to examine whether malalignment after triple arthrodesis leads to a higher grade of OA at long-term follow-up.
Between 1991 and 2002, 81 patients underwent a triple arthrodesis. Preoperatively, postoperatively, 3, 7.5 and 15 years after surgery, dorsoplantar (DP) and lateral X-rays were taken and used to evaluate the degree of OA and the geometry of the foot. The degree of OA was estimated using the Kellgren and Lawrence score. The geometry of the foot was assessed using Meary's angle; a Meary's angle exceeding 15° in DP and/or greater than -5 to 5° from the lateral view was defined as malalignment. In addition to the radiological evaluation, clinical scores (FFI and AOFAS) were recorded.
Thirty-five patients (40 feet) were available for analysis 15 years after surgery. In 19 cases there was an increase in ankle OA following the operation. Eight feet showed malalignment on the lateral view and 28 on the DP view. There was no difference in both an increase of ankle OA or clinical outcome between correct aligned feet and feet classified as malaligned. Thirty-three patients with 38 treated feet stated that they would decide to undergo the treatment again. Two patients would not want to undergo the same surgery again. The patients were satisfied with the result of surgery, clinical scores improved after surgery and remained stable in the long-term.
Triple arthrodesis is a salvage procedure in patients with a painful and deformed hindfoot and results in a clinically beneficial outcome, even 15 years after surgery. The present study did not show that malalignment after triple arthrodesis results in a higher grade of OA of the ankle joint in the long-term. The cause of the aggravation of OA is still not fully understood and needs further research. Nevertheless, clinical results are satisfying 15 years postoperatively.
疼痛、畸形和不稳定是跗关节融合（三关节融合术）的主要原因。短期和中期结果显示，术后活动度、功能和满意度有所提高。然而，相邻踝关节的骨关节炎（OA）被描述为一种长期并发症。足部的对线情况可能是一个影响因素。本研究的目的是探讨三关节融合术后的对线不良在长期随访中是否会导致更高程度的OA。
1991年至2002年期间，81例患者接受了三关节融合术。术前、术后、术后3年、7.5年和15年拍摄背跖位（DP）和侧位X线片，用于评估OA程度和足部形态。使用Kellgren和Lawrence评分评估OA程度。使用Meary角评估足部形态；DP位Meary角超过15°和/或侧位偏离-5至5°被定义为对线不良。除了影像学评估外，还记录了临床评分（FFI和AOFAS）。
术后15年，35例患者（40只足）可供分析。19例患者术后踝关节OA加重。8只足侧位显示对线不良，28只足DP位显示对线不良。对线正确的足和被分类为对线不良的足在踝关节OA增加或临床结果方面没有差异。33例患者（38只接受治疗的足）表示他们会决定再次接受该治疗。2例患者不想再次接受相同手术。患者对手术结果满意，术后临床评分改善并长期保持稳定。
三关节融合术是治疗后足疼痛和畸形患者的一种挽救性手术，即使在术后15年也能带来临床有益的结果。本研究未表明三关节融合术后的对线不良在长期会导致更高程度的踝关节OA。OA加重的原因仍未完全理解，需要进一步研究。尽管如此，术后15年的临床结果令人满意。
