Segal Ava D, Cyr Krista M, Stender Christina J, Whittaker Eric C, Hahn Michael E, Orendurff Michael S, Ledoux William R, Sangeorzan Bruce J
Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA.
Center for Limb Loss and MoBility, Rehabilitation Research and Development, Department of Veterans Affairs, Seattle, WA, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA, USA.
Clin Biomech (Bristol). 2018 May;54:42-53. doi: 10.1016/j.clinbiomech.2018.02.018. Epub 2018 Mar 5.
End-stage ankle arthritis is a debilitating condition that often requires surgical intervention after failed conservative treatments. Ankle arthrodesis is a common surgical option, especially for younger and highly active patients; however, ankle arthroplasty has become increasingly popular as advancements in implant design improve device longevity. The longitudinal differences in biomechanical outcomes between these surgical treatments remain indistinct, likely due to the challenges associated with objective study of a heterogeneous population.
Patients scheduled for arthroplasty (n = 27) and arthrodesis (n = 20) were recruited to participate in this three-year prospective study. Postoperative functional outcomes were compared at distinct annual time increments using measures of gait analysis, average daily step count and survey score.
Both surgical groups presented reduced pain, improved survey scores, and increased walking speed at the first-year postoperative session, which were generally consistent across the three-year follow-up. Arthrodesis patients walked with decreased sagittal ankle RoM, increased sagittal hip RoM, increased step length, and increased transient force at heel strike, postoperatively. Arthroplasty patients increased ankle RoM and cadence, with no changes in hip RoM, step length or heel strike transient force.
Most postoperative changes were detected at the first-year follow-up session and maintained across the three-year time period. Despite generally favorable outcomes associated with both surgeries, several underlying postoperative biomechanical differences were detected, which may have long-term functional consequences. Furthermore, neither technique was able to completely restore gait biomechanics to the levels of the contralateral unaffected limb, leaving potential for the development of improved surgical and rehabilitative treatments.
终末期踝关节关节炎是一种使人衰弱的病症，在保守治疗失败后通常需要手术干预。踝关节融合术是一种常见的手术选择，尤其对于年轻且活动量大的患者；然而，随着植入物设计的进步提高了器械使用寿命，踝关节置换术越来越受欢迎。这些手术治疗在生物力学结果方面的纵向差异仍不明确，这可能是由于对异质性人群进行客观研究存在挑战。
招募计划进行置换术（n = 27）和融合术（n = 20）的患者参与这项为期三年的前瞻性研究。使用步态分析、平均每日步数和调查评分等指标，在不同的年度时间增量下比较术后功能结果。
两个手术组在术后第一年时疼痛均减轻、调查评分改善且步行速度增加，在三年随访期间总体保持一致。融合术患者术后矢状面踝关节活动度降低、矢状面髋关节活动度增加、步长增加且足跟触地时瞬态力增加。置换术患者踝关节活动度和步频增加，髋关节活动度、步长或足跟触地瞬态力无变化。
大多数术后变化在第一年随访时被检测到，并在三年期间保持。尽管两种手术通常都有良好的结果，但仍检测到一些潜在的术后生物力学差异，这可能会产生长期功能影响。此外，两种技术都无法将步态生物力学完全恢复到对侧未受影响肢体的水平，这为改进手术和康复治疗的发展留下了空间。
