Ali A A, Forrester R A, O'Connor P, Harris N J
Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4BU, UK.
Spire Hospital and Leeds Beckett University, Jackson Avenue, Roundhay, Leeds LS8 1NT, UK.
Bone Joint J. 2018 Apr 1;100-B(4):475-479. doi: 10.1302/0301-620X.100B4.BJJ-2017-0963.
The aim of this study was to present a series of patients with aseptic failure of a total ankle arthroplasty (TAA) who were treated with fusion of the hindfoot using a nail.
A total of 23 TAAs, in 22 patients, were revised for aseptic loosening and balloon osteolysis to a hindfoot fusion by a single surgeon (NH) between January 2012 and August 2014. The procedure was carried out without bone graft using the Phoenix, Biomet Hindfoot Arthrodesis Nail. Preoperative investigations included full blood count, CRP and ESR, and radiological investigations including plain radiographs and CT scans. Postoperative plain radiographs were assessed for fusion. When there was any doubt, CT scans were performed.
The mean follow-up was 13.9 months (4.3 to 37.2). Union occurred at the tibiotalar joint in 22 ankles (95.6%) with one partial union. Union occurred at the subtalar joint in 20 ankles (87%) of cases with two nonunions. The nail broke in one patient with a subtalar nonunion and revision was undertaken. The only other noted complication was one patient who suffered a stress fracture at the proximal aspect of the nail, which was satisfactorily treated conservatively.
This study represents the largest group of patients reported to have undergone revision TAA to fusion of the hindfoot with good results Cite this article: Bone Joint J 2018;100-B:475-9.
本研究旨在介绍一系列接受全踝关节置换术（TAA）后无菌性失败并采用髓内钉进行后足融合治疗的患者。
2012年1月至2014年8月期间，由同一位外科医生（NH）对22例患者的23例全踝关节置换术进行翻修，因无菌性松动和气囊性骨质溶解而改为后足融合术。手术采用Biomet后足融合髓内钉（Phoenix），未使用骨移植。术前检查包括全血细胞计数、CRP和ESR，影像学检查包括X线平片和CT扫描。术后通过X线平片评估融合情况。如有疑问，则进行CT扫描。
平均随访时间为13.9个月（4.3至37.2个月）。22例踝关节（95.6%）胫距关节实现融合，1例部分融合。20例踝关节（87%）距下关节实现融合，2例未融合。1例距下关节未融合患者的髓内钉断裂，进行了翻修。唯一其他 noted 并发症是1例患者在髓内钉近端发生应力性骨折，经保守治疗效果满意。
本研究报道了接受全踝关节置换术翻修至后足融合术的最大患者群体，结果良好。引用本文：《骨与关节杂志》2018年；100-B：475-479。
