Quayle Jonathan, Shafafy Roozbeh, Khan Muhammad Asim, Ghosh Koushik, Sakellariou Anthony, Gougoulias Nikos
Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, GU16 7UJ, United Kingdom.
Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, GU16 7UJ, United Kingdom.
Foot Ankle Surg. 2018 Apr;24(2):137-142. doi: 10.1016/j.fas.2017.01.004. Epub 2017 Feb 3.
It is thought that arthroscopic ankle fusion offers improved outcomes over open fusion in terms of functional outcomes, time to fusion, length of stay and fewer complications. However, there are doubts about whether correction of established severe deformity can be achieved using the arthroscopic approach.
A retrospective review of medical records and radiographs at our hospital identified consecutive tibio-talar ankle fusions between April 2009 and March 2014 with minimum 1 year follow up. Records were scrutinised for type of arthrodesis, demographics, length of stay (LOS), time to fusion (TTF), pre- and postoperative deformity, complications and unplanned procedures. Significant factors in the complication group were then compared, using multivariate binary logistic backward stepwise regression to see if any factors were predictive.
There were 29 open and 50 arthroscopic ankle fusions (2 converted to open). Mean LOS was 1.93 versus 2.52 days (p=0.590). TTF was shorter after arthroscopic fusion 196d versus 146d (p=0.083). Severe deformity (>10°) was correctable to within 5° of neutral in the majority of cases (97% versus 96%, p=0.903). Union occurred in 83% versus 98% (p=0.0134). The open arthrodesis group had 9 (31%) complications (1 death-PE, 1 SPN injury, 5 non-unions, 1 delayed union and 1 wound infection) and 6 (25%) screw removals. The arthroscopic arthrodesis group had 4 (8%) complications (1 non-union, 1 reactivation of osteomyelitis and subsequent BKA, 1 wound infection, 1 delayed union) with 11 (24%) screw removals. After multi-variant regression analysis of all ankle fusions, low BMI was shown to be associated with complications (p=0.064).
Open arthrodesis was associated with a higher rate of complications and a lower rate of fusion. However, there was no significant difference in terms of LOS and ability to correct deformity compared to arthroscopic arthrodesis. Overall, low BMI was also associated with more complications.
人们认为，在功能结果、融合时间、住院时间和并发症较少方面，关节镜下踝关节融合术比开放融合术效果更好。然而，对于能否通过关节镜方法矫正已存在的严重畸形存在疑问。
对我院2009年4月至2014年3月期间连续进行的胫距踝关节融合术病例的病历和X线片进行回顾性分析，随访时间至少1年。仔细审查记录，包括融合类型、人口统计学资料、住院时间（LOS）、融合时间（TTF）、术前和术后畸形、并发症及非计划手术。然后对并发症组的显著因素进行比较，采用多变量二元逻辑向后逐步回归分析，以确定是否有任何因素具有预测性。
有29例开放踝关节融合术和50例关节镜下踝关节融合术（2例转为开放手术）。平均住院时间分别为1.93天和2.52天（p = 0.590）。关节镜融合术后融合时间较短，分别为196天和146天（p = 0.083）。在大多数病例中，严重畸形（>10°）可矫正至中立位5°以内（97%对96%，p = 0.903）。融合率分别为83%和98%（p = 0.0134）。开放融合术组有9例（31%）并发症（1例死亡 - 肺栓塞，1例腓总神经损伤，5例骨不连，1例延迟愈合和1例伤口感染），6例（25%）需取出螺钉。关节镜融合术组有4例（8%）并发症（1例骨不连，1例骨髓炎复发及随后的膝下截肢，1例伤口感染，1例延迟愈合），11例（24%）需取出螺钉。对所有踝关节融合术进行多变量回归分析后，低体重指数与并发症相关（p = 0.064）。
开放融合术并发症发生率较高，融合率较低。然而，与关节镜融合术相比，在住院时间和矫正畸形能力方面无显著差异。总体而言，低体重指数也与更多并发症相关。
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