Lee Moses, Choi Woo Jin, Han Seung Hwan, Jang Jinyoung, Lee Jin Woo
Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Republic of Korea.
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Republic of Korea.
Foot Ankle Surg. 2018 Dec;24(6):542-548. doi: 10.1016/j.fas.2017.07.006. Epub 2017 Jul 22.
Tibiotalocalcaneal (TTC) fusion using a retrograde intramedullary (IM) nail is an effective salvage option for terminal-stage hindfoot problems. However, as many patients who receive TTC fusion bear unfavorable medical comorbidities, the risk of nonunion, infection and other complications increases. This study was performed to identify the factors influencing outcomes after TTC fusion using a retrograde IM nail.
Between September 2008 and February 2012, 34 consecutive patients received TTC fusion using a retrograde IM nail for limb salvage. All patients had a minimum follow-up of two years. Throughout follow-up, standard ankle radiography was performed along with clinical outcome assessment using a visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society Ankle-Hind Foot Scale (AOFAS A/H scale) and the Foot and Ankle Outcome Score (FAOS). For the retrospective analysis, demographic factors, preoperative medical status, laboratory markers, and etiology were comprehensively reviewed using medical records. The success of the index operation was determined using clinical and radiological outcomes. Finally, the effect of each factor on failure after the operation was analyzed using univariate logistic regression.
In a mean of seven months, 82% (28/34) achieved union, as evaluated by standard radiography. All clinical outcome parameters improved significantly after the operation, including VAS, AOFAS A/H scale, and FAOS (P<0.001). At the last follow-up, five cases of nonunion with less than AOFAS A/H scale of 80 and two cases of below knee amputation due to uncontrolled infection were determined to be failures. None of the factors (etiology, demographics, laboratory markers and medical status) significantly influenced failures. However, uncontrolled DM significantly increased the failure rate with an odds ratio of 10 (P=0.029).
TTC fusion with a retrograde intramedullary nail is a successful treatment for complicated hindfoot problems such as traumatic osteoarthritis, Charcot arthropathy and failed TAA. However, it should be used judiciously in patients with uncontrolled DM, as the risk of failure increases.
Retrospective cohort study.
使用逆行髓内钉进行胫距跟（TTC）融合术是终末期后足问题的一种有效挽救方案。然而，由于许多接受TTC融合术的患者存在不良的合并症，骨不连、感染及其他并发症的风险增加。本研究旨在确定影响使用逆行髓内钉进行TTC融合术后疗效的因素。
2008年9月至2012年2月期间，34例连续患者接受了使用逆行髓内钉的TTC融合术以挽救肢体。所有患者的随访时间均至少为两年。在整个随访过程中，进行了标准的踝关节X线检查，并使用视觉模拟量表（VAS）评估疼痛的临床结局、美国矫形足踝协会踝-后足量表（AOFAS A/H量表）以及足踝结局评分（FAOS）。为进行回顾性分析，使用病历全面回顾了人口统计学因素、术前医疗状况、实验室指标及病因。根据临床和影像学结局确定索引手术是否成功。最后，使用单因素逻辑回归分析各因素对术后失败的影响。
平均7个月时，通过标准X线检查评估，82%（28/34）实现了骨愈合。术后所有临床结局参数均有显著改善，包括VAS、AOFAS A/H量表及FAOS（P<0.001）。在最后一次随访时，确定5例骨不连且AOFAS A/H量表评分低于80分以及2例因感染无法控制而进行膝下截肢的病例为失败病例。没有任何因素（病因、人口统计学、实验室指标及医疗状况）对失败有显著影响。然而，未控制的糖尿病显著增加了失败率，比值比为10（P=0.029）。
使用逆行髓内钉进行TTC融合术是治疗创伤性骨关节炎、夏科氏关节病及失败的全踝关节置换术等复杂后足问题的成功方法。然而，对于未控制糖尿病的患者应谨慎使用，因为失败风险会增加。
回顾性队列研究。
