Rogero Ryan, Tsai Justin, Fuchs Daniel, Shakked Rachel, Raikin Steven M
Rothman Institute, Philadelphia, Pennsylvania.
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Foot Ankle Spec. 2020 Aug;13(4):315-323. doi: 10.1177/1938640019863260. Epub 2019 Jul 26.
Tibiotalocalcaneal (TTC) arthrodesis implementing adjunctive allografts is a method of limb salvage for patients with complex hindfoot osseous deficits, though outcome results are limited. The purposes of this study were to assess functional and radiographic outcomes after TTC arthrodesis with femoral head allograft and retrospectively identify prognostic factors. The authors reviewed 24 TTC arthrodesis procedures with bulk femoral head allografts performed by a single surgeon from 2004 to 2016. Radiographic union at the ankle and subtalar joints along with stability of the allograft were assessed. Patients who had clinically successful arthrodeses were contacted to score the Foot and Ankle Ability Measure-Activities of Daily Living (FAAM-ADL) questionnaire, Visual Analog Scale (VAS) for pain, and Short Form-12 (SF-12) at a mean of 58.0 months (range, 28-102) postoperatively. Complete radiographic union of involved joints was achieved in 15 patients (63%) and in 75% (36/48) of all joints; 21 ankles (88%) were assessed to be radiographically stable at final follow-up. Three patients (13%) underwent revision arthrodesis at a mean of 18.9 months postoperatively, and 21 patients (88%) did not require additional surgery as of final follow-up. Patients significantly improved to a mean FAAM-ADL score of 71.5 from 36.3 (P < .001). The mean VAS for pain significantly improved from 77.2 to 32.9 (P < .001). Male sex (P = .08) and a lateral operative approach (P = .03) both resulted in worse outcomes. Use of a femoral head allograft with TTC arthrodesis can offer improved functional scores and sustained radiographic outcomes. Level IV: Case series.
采用辅助同种异体骨移植的胫距跟（TTC）关节融合术是挽救患有复杂后足骨缺损患者肢体的一种方法，不过其结果有限。本研究的目的是评估采用股骨头同种异体骨移植的TTC关节融合术后的功能和影像学结果，并回顾性确定预后因素。作者回顾了2004年至2016年由一名外科医生实施的24例采用大块股骨头同种异体骨移植的TTC关节融合术。评估了踝关节和距下关节的影像学愈合情况以及同种异体骨的稳定性。对临床关节融合成功的患者进行随访，以平均术后58.0个月（范围28 - 102个月）时的足踝功能能力测量-日常生活活动（FAAM-ADL）问卷、疼痛视觉模拟量表（VAS）以及简明健康调查量表（SF-12）进行评分。15例患者（63%）的受累关节实现了完全影像学愈合，所有关节中有75%（36/48）实现愈合；在末次随访时，21个踝关节（88%）经评估在影像学上稳定。3例患者（13%）在术后平均18.9个月时接受了翻修关节融合术，截至末次随访，21例患者（88%）无需额外手术。患者的FAAM-ADL平均评分从36.3显著提高至71.5（P < .001）。疼痛的平均VAS评分从77.2显著改善至32.9（P < .001）。男性（P = .08）和外侧手术入路（P = .03）均导致较差的结果。采用股骨头同种异体骨移植进行TTC关节融合术可提供改善的功能评分和持续的影像学结果。IV级：病例系列。
