踝关节融合与关节置换的有效性和安全性：一项前瞻性多中心研究。
Effectiveness and Safety of Ankle Arthrodesis Versus Arthroplasty: A Prospective Multicenter Study.
机构信息
Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington.
Spectrum Research, Tacoma, Washington.
出版信息
J Bone Joint Surg Am. 2019 Aug 21;101(16):1485-1494. doi: 10.2106/JBJS.18.01257.
BACKGROUND
Newer designs and techniques of total ankle arthroplasty (TAA) have challenged the assumption of ankle arthrodesis (AA) as the primary treatment for end-stage ankle arthritis. The objective of this study was to compare physical and mental function, ankle-specific function, pain intensity, and rates of revision surgery and minor complications between these 2 procedures and to explore heterogeneous treatment effects due to age, body mass index (BMI), patient sex, comorbidities, and employment on patients treated by 1 of these 2 methods.
METHODS
This was a multisite prospective cohort study comparing outcomes of surgical treatment of ankle arthritis. Subjects who presented after nonoperative management had failed received either TAA or AA using standard-of-treatment care and rehabilitation. Outcomes included the Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Physical and Mental Component Summary (PCS and MCS) scores, pain, ankle-related adverse events, and treatment success.
RESULTS
Five hundred and seventeen participants underwent surgery and completed a baseline assessment. At 24 months, the mean improvement in FAAM activities of daily living (ADL) and SF-36 PCS scores was significantly greater in the TAA group than in the AA group, with a difference between groups of 9 points (95% confidence interval [CI] = 3, 15) and 4 points (95% CI = 1, 7), respectively. The crude incidence risks of revision surgery and complications were greater in the AA group; however, these differences were no longer significant after adjusting for age, sex, BMI, and Functional Comorbidity Index (FCI). The treatment success rate was greater after TAA than after AA for those with an FCI of 4 (80% versus 62%) and not fully employed (81% versus 58%) but similar for those with an FCI score of 2 (81% versus 77%) and full-time employment (79% versus 78%).
CONCLUSIONS
At 2-year follow-up, both AA and TAA were effective. Improvement in several patient-reported outcomes was greater after TAA than after AA, without a significant difference in the rates of revision surgery and complications.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
背景
新型全踝关节置换术（TAA）的设计和技术挑战了踝关节融合术（AA）作为终末期踝关节关节炎主要治疗方法的假设。本研究的目的是比较这两种手术在身体和精神功能、踝关节特异性功能、疼痛强度以及翻修手术和小并发症发生率方面的差异，并探讨由于年龄、体重指数（BMI）、患者性别、合并症和就业等因素对接受这两种方法之一治疗的患者的异质治疗效果。
方法
这是一项多中心前瞻性队列研究，比较了手术治疗踝关节关节炎的结果。经非手术治疗失败的患者接受标准治疗护理和康复后，行 TAA 或 AA。结果包括足踝能力测量（FAAM）、36 项简短健康调查问卷（SF-36）生理和心理成分综合评分（PCS 和 MCS）、疼痛、踝关节相关不良事件和治疗成功。
结果
517 名患者接受手术并完成基线评估。在 24 个月时，TAA 组的 FAAM 日常生活活动（ADL）和 SF-36 PCS 评分的平均改善明显大于 AA 组，两组之间的差值分别为 9 分（95%置信区间 [CI] = 3，15）和 4 分（95% CI = 1，7）。AA 组翻修手术和并发症的粗发生率风险较高；然而，在调整年龄、性别、BMI 和功能合并症指数（FCI）后，这些差异不再显著。对于 FCI 为 4（80%比 62%）和未完全就业（81%比 58%）的患者，TAA 后治疗成功率大于 AA；而对于 FCI 评分为 2（81%比 77%）和全职就业（79%比 78%）的患者，两者相似。
结论
在 2 年随访时，AA 和 TAA 均有效。TAA 后几项患者报告结果的改善大于 AA，而翻修手术和并发症的发生率无显著差异。
证据水平
治疗性 II 级。有关证据水平的完整描述，请参阅作者说明。
Zotero 插件