Professor of Orthopedic Surgery, University of Sevilla (Spain), Head of Foot Ankle Unit at University Hospital Virgen del Rocío, Sevilla, Spain.
(2)Foot and Ankle Surgeon, University Hospital Virgen del Rocío, Sevilla, Spain.
J Foot Ankle Surg. 2021 Mar-Apr;60(2):417-420. doi: 10.1053/j.jfas.2020.06.002. Epub 2020 Jun 15.
Currently, total ankle replacement (TAR) is an alternative to arthrodesis in selected patients, with the anterior approach being the most widely used to carry it out. Regardless of the type of implant used, the pins for bone resection guides, chisels, and the saw for distal tibial resection can endanger the neurovascular and tendon structures that lie in intimate proximity to the posterior aspect of the ankle. Additionally, there is a documented complication rate of up to 15.3% in such surgery. We have implemented a protective posteromedial approach that complements the anterior approach to reduce this risk of intraoperative iatrogenic injury. Using this method we introduce a protective instrument that separates the posterior anatomical structures from the posterior cortex of the tibia. This article describes the surgical technique used to carry out TAR through an anterior approach in a safer way, without increasing complications or the duration of real-time surgery.
目前，全踝关节置换术（TAR）是某些患者选择的关节融合术的替代方法，其中前入路是最常用的方法。无论使用哪种植入物，用于骨切除引导的销钉、凿子和用于胫骨远端切除的锯子都可能危及位于踝关节后表面附近的神经血管和肌腱结构。此外，此类手术的并发症发生率有记录高达 15.3%。我们已经实施了一种保护后内侧入路，与前入路相结合，以降低术中医源性损伤的风险。使用这种方法，我们引入了一种保护仪器，将后解剖结构与胫骨后皮质分开。本文描述了通过更安全的前入路进行 TAR 的手术技术，不会增加并发症或实时手术的时间。
