Cottom James M, Plemmons Britton S, Douthett Steven M
Fellowship Director, Florida Orthopedic Foot & Ankle Center, Sarasota, FL.
Fellow, Florida Orthopedic Foot & Ankle Center, Sarasota, FL.
J Foot Ankle Surg. 2018 Nov-Dec;57(6):1161-1166. doi: 10.1053/j.jfas.2018.06.012.
Total ankle replacement can be a viable option for patients with end-stage ankle arthritis associated with coronal plane deformity. With proper ankle balancing, a well-aligned ankle implant can be maintained over time and provide successful patient outcomes. The purpose of this study was to evaluate radiographic and subjective outcomes in patients with ankle arthritis along with coronal plane deformity who underwent total ankle arthroplasty with a 3-piece mobile-bearing implant. Our primary inclusion criterion was patients who demonstrated more than 5° of tibiotalar coronal deformity in either varus or valgus direction. Sixty-three consecutive patients who underwent total ankle replacement were reviewed. Of these, 25 (39.7%) met the inclusion criteria. Sixteen (64%) patients had a varus deformity (Group 1) and 9 (36%) had valgus deformity (Group 2) preoperatively. Alignment was evaluated radiographically at 5 different intervals: preoperative, immediate postoperative, and 6, 12, and 36 months postoperative. In patients with varus deformity, the mean tibiotalar angle was 12.6°, 0.8°, 1.0°,1.0°, and 0.8° for preoperative, immediate postoperative, and 6, 12, and 36 months, respectively. The same measurements and intervals for patients with valgus deformity were found to be 10.3°, 1.4°, 1.6°, 1.4°, and 1.4°. A statistically significant difference was observed in preoperative and postoperative coronal plane deformity. This correction was maintained at final follow-up visit. American Orthopaedic Foot and Ankle Society scores and visual analogue scale scores were recorded as well, and statistically significant improvements in preoperative and postoperative scores were found (p < .001). In conclusion, coronal plane deformity correction of the ankle can be accomplished and maintained in total ankle replacement procedures with proper soft tissue balancing and osseous procedures as indicated.
对于终末期踝关节关节炎合并冠状面畸形的患者，全踝关节置换术可能是一种可行的选择。通过适当的踝关节平衡，随着时间的推移，可以维持良好对齐的踝关节植入物，并为患者带来成功的治疗结果。本研究的目的是评估接受三件式活动轴承植入物全踝关节置换术的踝关节关节炎合并冠状面畸形患者的影像学和主观结果。我们的主要纳入标准是在内外翻方向上显示胫距冠状面畸形超过5°的患者。对63例连续接受全踝关节置换术的患者进行了回顾。其中，25例（39.7%）符合纳入标准。术前，16例（64%）患者有内翻畸形（第1组），9例（36%）有外翻畸形（第2组）。在5个不同时间点进行影像学评估对线情况：术前、术后即刻以及术后6个月、12个月和36个月。对于内翻畸形患者，术前、术后即刻以及术后6个月、12个月和36个月的平均胫距角分别为12.6°、0.8°、1.0°、1.0°和0.8°。外翻畸形患者的相同测量值和时间点分别为10.3°、1.4°、1.6°、1.4°和1.4°。术前和术后冠状面畸形存在统计学显著差异。这种矫正在最终随访时得以维持。还记录了美国矫形足踝协会评分和视觉模拟量表评分，术前和术后评分有统计学显著改善（p < .001）。总之，在全踝关节置换手术中，通过适当的软组织平衡和必要的骨操作，可以实现并维持踝关节冠状面畸形的矫正。
