踝关节活动度在三组件全踝关节置换术后的变化。
Ankle Range of Motion Following 3-Component Total Ankle Arthroplasty.
机构信息
Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland.
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Foot Ankle Int. 2021 Jan;42(1):31-37. doi: 10.1177/1071100720955145. Epub 2020 Sep 26.
BACKGROUND
Although surgeons have argued that preserving motion at the level of the ankle joint may be crucial for the long-term success in the treatment of end-stage ankle osteoarthritis, there is little evidence regarding the potential of total ankle arthroplasty (TAA) to increase ankle range of motion (ROM). In addition, the effect of a percutaneous heel cord lengthening (HCL) during TAA on ankle motion is poorly understood.
METHODS
A total of 357 primary TAAs treated with a 3-component device (336 patients, mean age 62.6 [24-85] years) performed between May 2003 and November 2017 were retrospectively analyzed. Sagittal ankle ROM was assessed according to a previously published protocol preoperatively (PreOP), 1 year postoperatively (PostOP), and at the last available follow-up (LastFU). Pain assessed on a visual analog scale (VAS) was assessed at the same time points. The effect of a percutaneous HCL on ankle ROM and VAS for pain was also evaluated.
RESULTS
Preoperative ankle ROM increased from mean 31.3 (0-69) to 33.9 (5-65) degrees 1 year postoperatively ( = .0002) and decreased to 31.9 (5-70) degrees at the LastFU ( = .007). Percutaneous HCL showed no effect on ankle ROM development after TAA ( = .141). Ankle ROM improvement after TAA (PreOP to LastFU) was higher in ankles with lower preoperative ankle motion ( < .0001). A lower ankle ROM at the last follow-up tended to be associated with a higher pain level ( = .056).
CONCLUSION
Although ankles with a lower preoperative sagittal ROM gained motion, the current data suggest that TAA has little potential to increase the preoperative available ankle motion. In some patients with a high preoperative ankle ROM, a slight decrease of ankle motion was observed postoperatively. Patients with limited ankle motion at long-term follow-up tended toward experiencing higher pain levels. The short- and long-term effect of a percutaneous HCL on ankle ROM following TAA was minimal.
LEVEL OF EVIDENCE
Level III, retrospective comparative series.
背景
尽管外科医生认为在踝关节水平保留运动能力对于治疗晚期踝关节骨关节炎的长期成功可能至关重要，但关于全踝关节置换术（TAA）增加踝关节活动范围（ROM）的潜力的证据很少。此外，TAA 期间经皮跟腱延长术（HCL）对踝关节运动的影响知之甚少。
方法
回顾性分析了 2003 年 5 月至 2017 年 11 月期间使用 3 组件设备治疗的 357 例初次 TAA（336 例患者，平均年龄 62.6[24-85]岁）。根据先前发表的方案评估术前（PreOP）、术后 1 年（PostOP）和最后一次随访时的矢状面踝关节 ROM。同时评估视觉模拟评分（VAS）评估的疼痛。还评估了经皮 HCL 对踝关节 ROM 和 VAS 疼痛的影响。
结果
术前踝关节 ROM 从平均 31.3（0-69）度增加到术后 1 年的 33.9（5-65）度（ =.0002），在最后一次随访时降至 31.9（5-70）度（ =.007）。TAA 后，经皮 HCL 对踝关节 ROM 的发展没有影响（ =.141）。TAA 后（PreOP 至 LastFU）踝关节 ROM 的改善在术前踝关节运动较低的踝关节中更高（ <.0001）。最后随访时踝关节 ROM 较低往往与疼痛水平较高相关（ =.056）。
结论
尽管术前矢状面 ROM 较低的踝关节获得了运动能力，但目前的数据表明 TAA 几乎没有增加术前可用踝关节运动的潜力。在一些术前踝关节 ROM 较高的患者中，术后观察到踝关节运动略有下降。在长期随访中踝关节运动受限的患者往往会经历更高的疼痛水平。TAA 后经皮 HCL 对踝关节 ROM 的短期和长期影响最小。
证据水平
III 级，回顾性比较系列。
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