Hordyk Peter J, Fuerbringer Brent A, Roukis Thomas S
PGY3 Podiatric Medicine and Surgery Resident, Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI.
Attending Staff, Orthopaedic Center, Gundersen Healthcare System, La Crosse, WI.
J Foot Ankle Surg. 2018 May-Jun;57(3):521-526. doi: 10.1053/j.jfas.2017.11.017. Epub 2018 Mar 1.
The most common reason for a revision total ankle replacement procedure is a painful, stiff ankle even after the initial surgery. Limited and conflicting data are available regarding the change in sagittal foot and ankle range of motion after revision total ankle replacement surgery. We sought to determine whether revision total ankle replacements would reduce compensatory midfoot range of motion. In determining this, a novel radiographic measurement system with stable osseous landmarks is used. A retrospective medical record review of patients who had undergone revision total ankle replacement from January 2009 to June 2016 was performed. Thirty-three patients (33 ankles) underwent revision total ankle replacement surgery and met the inclusion criteria with a mean follow-up period of 28.39 ± 14.68 (range 2 to 59) months. Investigation of preoperative and postoperative weightbearing lateral radiographic images was performed to determine the global foot and ankle, isolated ankle, and isolated midfoot sagittal ranges of motion. Statistical analysis revealed a significant increase in ankle range of motion (p = .046) and a significant decrease in midfoot range of motion (p < .001) from preoperatively to postoperatively. The change in global foot and ankle range of motion was not significant (p = .53). For this patient population, the increased ankle range of motion effectively resulted in less compensatory midfoot range of motion.
全踝关节置换翻修手术最常见的原因是即使在初次手术后踝关节仍疼痛、僵硬。关于全踝关节置换翻修手术后矢状面足踝活动度变化的数据有限且相互矛盾。我们试图确定全踝关节置换翻修术是否会减少中足的代偿性活动度。在确定这一点时，使用了一种具有稳定骨性标志的新型放射学测量系统。对2009年1月至2016年6月期间接受全踝关节置换翻修术的患者进行了回顾性病历审查。33例患者（33个踝关节）接受了全踝关节置换翻修手术，符合纳入标准，平均随访期为28.39±14.68（范围2至59）个月。对术前和术后负重位侧位放射影像进行研究，以确定全足踝、单独踝关节和单独中足的矢状面活动度。统计分析显示，从术前到术后，踝关节活动度显著增加（p = 0.046），中足活动度显著降低（p < 0.001）。全足踝活动度的变化不显著（p = 0.53）。对于该患者群体，踝关节活动度的增加有效地减少了中足的代偿性活动度。
