Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland.
Bone Joint J. 2019 Jun;101-B(6):682-690. doi: 10.1302/0301-620X.101B6.BJJ-2018-0932.R2.
There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure.
A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs.
Postoperatively, the mean score for pain, using a visual analogue scale, decreased significantly from 4.3 to 2.5 points and the mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 59 to 75 points (both p < 0.001). The mean TLS angle increased significantly by 6.6°; the mean TOR decreased significantly by 0.24 (p < 0.001). Radiological evaluation showed an improvement or no progression of sagittal ankle joint OA in 32 ankles (82%), while seven ankles (18%) showed further progression.
A flexion osteotomy effectively improved the congruency of the ankle joint. In 30 patients (77%), the joint could be saved, whereas in nine patients (23%), the treatment delayed a joint-sacrificing procedure. Cite this article: 2019;101-B:682-690.
关于如何处理胫骨远端后屈畸形伴踝关节骨关节炎（OA）患者，相关信息较少。本研究的目的是评估通过屈曲截骨术治疗这种畸形的功能和放射学结果，并评估该手术后 OA 的进展情况。
2010 年至 2015 年，共 39 例（12 名女性，27 名男性；平均年龄 47 岁（28 至 72 岁））胫骨远端后屈畸形患者接受了屈曲截骨术治疗。9 例（23%）患者在平均 21 个月（9 至 36 个月）后需要转为全踝关节置换术（7 例）或融合术（2 例）。30 例（77%）患者，平均随访 30 个月（24 至 76 个月），进一步评估。在负重前后的 X 线片上评估功能结果、改良 Kellgren 和 Lawrence 评分的踝关节矢状面 OA、胫骨外侧表面（TLS）角和距骨外移率（TOR）。
术后，视觉模拟评分法（VAS）疼痛评分从 4.3 分显著降至 2.5 分，美国矫形足踝协会（AOFAS）后足评分从 59 分显著提高至 75 分（均 p < 0.001）。TLS 角平均增加 6.6°，TOR 平均减少 0.24（均 p < 0.001）。放射学评估显示 32 个踝关节（82%）的矢状面踝关节 OA 改善或无进展，而 7 个踝关节（18%）进展。
屈曲截骨术有效地改善了踝关节的吻合度。在 30 例（77%）患者中，关节得以保留，而在 9 例（23%）患者中，治疗延迟了关节牺牲的程序。
Nadler SF, et al. J Bone Joint Surg Br. 2019;101-B:682-690.
