van der Vliet Quirine M J, Hietbrink Falco, Casari Fabio, Leenen Luke P H, Heng Marilyn
1 Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, MA, USA.
2 Department of Traumatology, University Medical Center Utrecht, Utrecht, the Netherlands.
Foot Ankle Int. 2018 Sep;39(9):1062-1069. doi: 10.1177/1071100718777492. Epub 2018 Jun 4.
Subtalar arthrodesis is a common salvage operation for posttraumatic subtalar arthritis. This study aimed to identify factors associated with functional outcomes and quality of life after subtalar fusion for posttraumatic subtalar arthritis after calcaneal fracture.
This is a retrospective study with follow-up by questionnaire in two level 1 trauma centers. Patients who underwent subtalar arthrodesis for posttraumatic arthritis after a calcaneal fracture between 2001 and 2016 were identified and contacted for completion of a survey consisting of the Foot and Ankle Ability Measure (FAAM), Maryland Foot Score (MFS), Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire, EuroQol 5-dimensional (EQ-5D) questionnaire, and EuroQol visual analog scale (EQ-VAS). Exclusion criteria were initial subtalar arthrodesis at an outside facility, primary arthrodesis for fracture, initial arthrodesis earlier than 2001, amputation of the fused foot or leg, younger than 18 years at time of fusion, and inability to communicate in English. A total of 159 patients met our inclusion criteria. Eighty-four patients completed the questionnaires, resulting in a response rate of 59%.
Median FAAM score was 79 (interquartile range [IQR], 48-90), median MFS was 74 (IQR, 56-86), and median PROMIS PF was 45 (IQR, 38-51). Quality of life was significantly lower when compared to a reference population ( P = .001). Smoking was independently associated with worse outcomes. Complications after fusion (such as nonunion, implant failure, and infectious complications), high-energy trauma, and ipsilateral injury were also predictors for poorer outcomes.
Acceptable functional outcomes and quality of life were observed after subtalar fusion. Smoking, complications after subtalar fusion, high-energy trauma, and presence of ipsilateral injuries were independently associated with worse functionality and quality of life.
Prognostic level III, comparative series.
距下关节融合术是创伤后距下关节炎常见的挽救性手术。本研究旨在确定跟骨骨折后创伤性距下关节炎行距下关节融合术后功能结局和生活质量的相关因素。
这是一项在两个一级创伤中心进行问卷调查随访的回顾性研究。确定2001年至2016年间因跟骨骨折后创伤性关节炎接受距下关节融合术的患者，并联系他们完成一份调查问卷，该问卷包括足踝能力测量量表（FAAM）、马里兰足部评分（MFS）、患者报告结局测量系统身体功能（PROMIS PF，简表10a）问卷、欧洲五维健康量表（EQ-5D）问卷和欧洲五维健康量表视觉模拟量表（EQ-VAS）。排除标准为在外院首次行距下关节融合术、骨折一期融合术、2001年之前首次行融合术、融合足部或腿部截肢、融合时年龄小于18岁以及无法用英语交流。共有159例患者符合纳入标准。84例患者完成了问卷调查，回复率为59%。
FAAM评分中位数为79（四分位间距[IQR]，48 - 90），MFS中位数为74（IQR，56 - 86），PROMIS PF中位数为45（IQR，38 - 51）。与参照人群相比，生活质量显著较低（P = .001）。吸烟与较差的结局独立相关。融合术后并发症（如骨不连、植入物失败和感染性并发症）、高能创伤和同侧损伤也是预后较差的预测因素。
距下关节融合术后观察到了可接受的功能结局和生活质量。吸烟、距下关节融合术后并发症、高能创伤和同侧损伤的存在与较差的功能和生活质量独立相关。
预后III级，比较性系列研究。
