Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Biomed Res Int. 2019 Jun 17;2019:7630868. doi: 10.1155/2019/7630868. eCollection 2019.
It is controversial whether supramalleolar osteotomy is suitable for Takakura Stage 3B osteoarthritis or not. The aim of this study was to evaluate the outcomes of supramalleolar osteotomy in patients with Takakura 3B osteoarthritis. From February 2008 to August 2013, supramalleolar osteotomy was performed in 21 patients matching the inclusion criteria. The mean patient age at operation was 53.7±5.8 years (range: 39 to 61 years). The mean duration of follow-up was 87.7±19.5 months (range: 61 to 125 months). The radiologic evaluation included the tibial articular surface (TAS) angle, tibial lateral surface (TLS) angle, and talar tilt (TT) angle. Functional assessment was performed with use of the AOFAS, VAS, SF-36, and AOS. All patients were followed. TAS angle improved from 82.8±2.4 to 90.3±2.3. TLS angle changed from 77.5±2.8 to 79.4±2.7. The preoperative TT angle and postoperative TT angle were 13.4±3.6 to 4.8±3.6, respectively. For functional evaluation, the preoperative VAS and AOFAS-AH scores were 5.7±1.3 and 48.0±15.8, while the postoperative VAS and AOFAS-AH scores were 2.5±1.9 and 74.8±11.5. The mean SF-36 scale improved from 41.2±13.1 to 66.7±14.9. The AOS score improved from 61.4±12.5 to 27.5±17.8. 1 patient underwent total ankle replacement 3 years postoperatively. 4 patients remained stage 3B including the TAR one. 4 improved to stage 3A, 11 improved to stage 2, and 2 improved to stage 1. Supramalleolar osteotomy combined with auxiliary procedures can restore the malalignment of ankle joint and modify the abnormal stress distribution so as to achieve functional improvement and improve radiographic stages.
对于 Takakura 3B 期骨关节炎是否适合行距骨上截骨术存在争议。本研究旨在评估距骨上截骨术治疗 Takakura 3B 期骨关节炎的疗效。2008 年 2 月至 2013 年 8 月，符合纳入标准的 21 例患者接受了距骨上截骨术。手术时患者的平均年龄为 53.7±5.8 岁（范围：39 岁至 61 岁）。平均随访时间为 87.7±19.5 个月（范围：61 个月至 125 个月）。影像学评估包括胫骨关节面（TAS）角、胫骨外侧表面（TLS）角和距骨倾斜角（TT）。采用美国足踝外科协会（AOFAS）评分、视觉模拟评分（VAS）、SF-36 评分和踝关节术后评分（AOS）进行功能评估。所有患者均获得随访。TAS 角由 82.8±2.4°改善至 90.3±2.3°。TLS 角由 77.5±2.8°变为 79.4±2.7°。术前 TT 角和术后 TT 角分别为 13.4±3.6°和 4.8±3.6°。在功能评估方面，术前 VAS 和 AOFAS-AH 评分分别为 5.7±1.3 和 48.0±15.8，术后 VAS 和 AOFAS-AH 评分分别为 2.5±1.9 和 74.8±11.5。SF-36 量表平均得分由 41.2±13.1 提高至 66.7±14.9。AOS 评分由 61.4±12.5 提高至 27.5±17.8。术后 3 年，1 例患者行全踝关节置换术。4 例患者仍为 3B 期（包括 1 例 TAR）。4 例改善至 3A 期，11 例改善至 2 期，2 例改善至 1 期。距骨上截骨术结合辅助手术可以矫正踝关节的对线不良，改变异常的应力分布，从而实现功能改善，改善影像学分期。
