Perez-Aznar Adolfo, Gonzalez-Navarro Blanca, Bello-Tejeda Laiz L, Alonso-Montero Carolina, Lizaur-Utrilla Alejandro, Lopez-Prats Fernando A
Ankle and Foot Unit, Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax, s/n. 03600, Elda, Alicante, Spain.
Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain.
Int Orthop. 2021 Sep;45(9):2299-2305. doi: 10.1007/s00264-020-04904-3. Epub 2021 Jan 14.
To evaluate prospectively the functional outcomes of tibiotalocalcaneal (TTC) arthrodesis with a contemporary retrograde intramedullary nail after a minimum follow-up of five years.
Sixty-one patients with a mean age of 51.3 (range, 18-79) years were included in the study. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society Ankle Hindfoot score (AOFAS), Short-Form 12-item Health Survey (SF12), and visual analog scales (VAS) for both pain and patient satisfaction. Radiographic evaluation was also assessed.
The mean post-operative follow-up was 6.8 (range, 5-8) years. Mean AOFAS and SF12 scores significantly improved at the final follow-up (p < 0.001), and the mean VAS for pain significantly decreased (p < 0.001). At the final follow-up, only five (8.2%) patients gave an AOFAS score of less than 50, 52 (85.2%) were satisfied with their surgery, and 32 (52.4%) returned to their employment. There were two tibiotalar joint nonunions that required re-operations, and another patient required re-operation for screw removal. There was no deep infection.
The retrograde intramedullary nail provided a stable TTC arthrodesis with a high union rate, acceptable functional outcomes, and a low severe complication rate. This procedure appears to offer a reliable salvage option for TTC arthrodesis in patients with severe ankle and hindfoot degeneration.
前瞻性评估采用现代逆行髓内钉进行胫距跟（TTC）关节融合术至少随访五年后的功能结果。
本研究纳入了61例平均年龄为51.3岁（范围18 - 79岁）的患者。使用美国矫形足踝协会踝后足评分（AOFAS）、简短健康调查问卷12项（SF12）以及疼痛和患者满意度的视觉模拟量表（VAS）对功能结果进行评估。同时也进行了影像学评估。
术后平均随访时间为6.8年（范围5 - 8年）。在末次随访时，平均AOFAS和SF12评分显著改善（p < 0.001），疼痛的平均VAS显著降低（p < 0.001）。在末次随访时，只有5例（8.2%）患者的AOFAS评分低于50分，52例（85.2%）对手术满意，32例（52.4%）恢复了工作。有2例胫距关节不愈合需要再次手术，另有1例患者需要再次手术取出螺钉。无深部感染。
逆行髓内钉为TTC关节融合术提供了稳定的固定，融合率高，功能结果可接受，严重并发症发生率低。该手术似乎为严重踝关节和后足退变患者的TTC关节融合术提供了一种可靠的挽救选择。
