Persaud Sham J, Catanzariti Alan R
Resident, Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA.
Faculty, Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA.
J Foot Ankle Surg. 2019 Jul;58(4):785-791. doi: 10.1053/j.jfas.2018.11.022. Epub 2019 Apr 20.
Subtalar joint distraction arthrodesis has been recommended for the treatment of conditions such as nonunion or malunion of subtalar joint arthrodesis posttraumatic arthritis. Both conditions are difficult to treat, because the deformities created in the frontal and sagittal planes of these conditions are complex. If these malalignments are not addressed, ankle joint instability and wear occur over time. In general, either autograft or allograft bone has been used to perform distraction arthrodesis of the subtalar joint. Although studies have shown successful use, there have been complications. Autografts have resulted in donor site morbidity and limitations on graft size, and allografts have shown high nonunion rates. Both autografts and allografts have shown graft collapse over time. Recent literature has discussed the use of tantalum technology to span large defects in bone healing. Studies have shown that tantalum provides superior strength and bone incorporation compared with autografts and allografts. This case series presents 2 cases in which tantalum truss technology was used for distraction arthrodesis. Although this series is limited in patient numbers, both cases show effective graft incorporation with no loss in height over time and earlier return to activity compared with previous studies that used autograft and allograft wedges.
距下关节撑开融合术已被推荐用于治疗距下关节融合术不愈合或畸形愈合、创伤后关节炎等病症。这两种病症都难以治疗，因为这些病症在额状面和矢状面产生的畸形很复杂。如果这些排列不齐的问题得不到解决，随着时间的推移会出现踝关节不稳定和磨损。一般来说，自体骨移植或异体骨移植都曾被用于进行距下关节撑开融合术。尽管研究表明使用成功，但也出现了并发症。自体骨移植导致供区发病以及移植骨大小受限，而异体骨移植则显示出高不愈合率。自体骨移植和异体骨移植都显示出移植骨随时间推移出现塌陷。最近的文献讨论了使用钽技术来跨越骨愈合中的大缺损。研究表明，与自体骨移植和异体骨移植相比，钽具有更强的强度和骨结合能力。本病例系列展示了2例使用钽桁架技术进行撑开融合术的病例。尽管该系列病例数量有限，但与之前使用自体骨移植和异体骨移植楔形物的研究相比，这两个病例均显示移植骨有效融合，且随时间推移高度无丢失，并且能更早恢复活动。
