关节镜下踝关节融合术在老年患者中，对于严重畸形的踝关节与轻度畸形的踝关节相比，提供了相似的满意手术结果。

Arthroscopic Ankle Arthrodesis Provides Similarly Satisfactory Surgical Outcomes in Ankles With Severe Deformity Compared With Mild Deformity in Elderly Patients.

机构信息

Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

Arthroscopy. 2020 Oct;36(10):2738-2747. doi: 10.1016/j.arthro.2020.05.036. Epub 2020 Jun 1.

DOI:10.1016/j.arthro.2020.05.036

PMID:32497657

Abstract

PURPOSE

To evaluate the surgical outcome in terms of radiographic measurements, functional outcomes, and complications following arthroscopic ankle arthrodesis (AAA) in patients 60 years of age or older, and to compare the results of patients with mildly deformed ankle with those of patients with severely deformed ankle.

METHODS

We retrospectively reviewed patients who underwent AAA with 3 cannulated screws between January 2008 and December 2017 and followed postoperatively for at least 24 months. All included patients were 60 years of age or older. Demographic data and radiographic and functional outcomes were compared between patients with coronal deformity of less than 15° (group I) and those with a deformity equal to or greater than 15 degrees (group II).

RESULTS

A total of 41 patients with a mean age of 70.6 years were included (group I, n = 26; group II, n = 15) and mean follow-up was 51.4 months. Group II had significantly more severe preoperative coronal deformity of tibiotalar angle than group I (20.1 ± 2.9 vs 6.6 ± 4.1°, P < .01). Near-normal tibiotalar alignment was achieved postoperatively in both groups (group I, 3.4 ± 3.3 vs group II, 4.7 ± 3.1°, P = .227). Union was achieved in 39 (95.1%) patients with 2 cases in group I experiencing non-union. Union rate, mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and visual analog scale pain scores were not significantly different between the 2 groups at final follow-up.

CONCLUSIONS

AAA is a reliable procedure for end-stage ankle arthritis in patients 60 years of age or older resulting in a high union rate, encouraging radiographic and functional outcomes, and a low complication rate, even in cases with severe preoperative deformity. In addition, arthroscopic intra-articular malleolar osteotomy was a useful technique for correcting severe coronal deformity in our series.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

摘要

目的

评估 60 岁及以上患者行关节镜下踝关节融合术（AAA）的放射学测量、功能结果和并发症，并比较轻度畸形和重度畸形患者的结果。

方法

我们回顾性分析了 2008 年 1 月至 2017 年 12 月期间接受 3 枚空心螺钉 AAA 的患者，并至少随访 24 个月。所有纳入的患者年龄均在 60 岁及以上。比较冠状面畸形小于 15°（I 组）和畸形等于或大于 15 度（II 组）的患者之间的人口统计学数据、影像学和功能结果。

结果

共纳入 41 例平均年龄为 70.6 岁的患者（I 组 n=26；II 组 n=15），平均随访时间为 51.4 个月。与 I 组相比，II 组术前距骨-跟骨角的冠状面畸形更为严重（20.1±2.9°vs 6.6±4.1°，P<.01）。两组术后均获得接近正常的距骨-跟骨对线（I 组 3.4±3.3°，II 组 4.7±3.1°，P=.227）。39 例（95.1%）患者获得融合，其中 I 组有 2 例出现不愈合。两组最终随访时的融合率、美国矫形足踝协会踝关节-后足评分、视觉模拟评分疼痛均无显著差异。