Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK.
Foot Ankle Spec. 2021 Feb;14(1):79-88. doi: 10.1177/1938640020980914. Epub 2020 Dec 20.
Failure of ankle arthrodesis or total ankle replacement (TAR) results in a challenging clinical situation and may take the form of symptomatic nonunion following arthrodesis and aseptic or infective loosening following TAR. Revision in these scenarios is technically demanding, and if associated with subtalar degeneration, conversion to tibiotalocalcaneal (TTC) arthrodesis may be required, with use of bone grafting to maintain length and reduce disability. Fibular strut grafting in the form of pillars or columns, potentially supplemented by tricortical and iliac graft, may be used in association with intramedullary TTC nailing or lateral plating and has demonstrated encouraging fusion rates. In this technical note, we review the history of this technique and report indications and surgical approach. Furthermore, of 6 cases (mean age 69.8 years) treated at our institution and followed at 13 months (range, 8 to 20 months), 5 (83%) were clinically and radiologically united, and patients were satisfied with the outcome of surgery. One patient with a background of chronic kidney disease remained dissatisfied with no union achieved, persistent pain, and awaiting a below-the-knee amputation. No other complications were observed. TTC fusion augmented with fibular columns and iliac crest autograft is an option to treat combined ankle and subtalar joint pathologies with significant talar bone loss. Level V (technical note).
踝关节融合或全踝关节置换术（TAR）失败会导致棘手的临床情况，可能表现为融合术后有症状的骨不连，以及 TAR 后无菌性或感染性松动。在这些情况下进行翻修技术要求较高，如果伴有距下关节退变，可能需要转换为距下跟骨（TTC）融合术，同时使用植骨来维持长度并减轻残疾。可以使用腓骨支柱或柱状植骨，可能还需要附加皮质骨和髂骨植骨，与髓内 TTC 钉固定或外侧钢板固定联合使用，融合率令人鼓舞。在本技术说明中，我们回顾了该技术的历史，并报告了适应证和手术入路。此外，在我们机构治疗的 6 例患者（平均年龄 69.8 岁）中，随访 13 个月（范围 8 至 20 个月），5 例（83%）在临床和影像学上均愈合，患者对手术结果满意。1 例患有慢性肾脏病的患者仍不满意，未实现愈合，持续疼痛，等待膝下截肢。未观察到其他并发症。用腓骨柱和髂嵴自体骨增强的 TTC 融合是治疗伴有明显距骨骨丢失的踝关节和距下关节联合病变的一种选择。5 级（技术说明）。
