Orthopaedic Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Sci Rep. 2021 Feb 23;11(1):4381. doi: 10.1038/s41598-021-83946-y.
Posttraumatic ankle osteoarthritis (OA) represents a significant challenge to orthopedic surgeons, especially in cases of anterior talar translation and concomitant impaction of the anterior distal tibial plafond. The aim of this study was to evaluate the clinical outcomes of an intra-articular osteotomy for the management of these patients. A total of 21 patients meeting our criteria were retrospectively reviewed. Sixteen patients sustained initial pilon fractures, while five patients had Weber type C ankle fractures. Anterior distal tibial plafond-plasty was performed to address the impaction and anterior translation of the talus. The American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) score were utilized as clinical outcomes. The lateral talar station (LTS), tibial lateral surface (TLS) angle, tibial anterior surface angle and talocrural angle were evaluated pre- and postoperatively. The modified Kellgren-Lawrence score was used for the evaluation of sagittal ankle OA. The average age at surgery was 35 years, and the average follow-up duration was 34 months. The AOFAS hindfoot score increased from 26 to 71 (p < 0.01), and the VAS score improved from 7 to 2 (p < 0.01). The LTS improved from 9.0 to 2.3 mm (p < 0.01), and the TLS angle improved from 72° to 81° (p < 0.01). Of the 21 patients, 18 showed improvement in or no worsening of ankle OA on the sagittal plane, while 3 developed advanced ankle OA. A congruent ankle joint on the sagittal plane could be achieved by anterior distal tibial plafond-plasty. This is a valuable treatment option for the salvage of posttraumatic ankle OA with anterior translation of the talus.
创伤性踝关节炎（OA）是骨科医生面临的重大挑战，尤其是对于距骨前移位和前胫骨远端距骨平台塌陷的患者。本研究旨在评估关节内截骨术治疗这些患者的临床效果。我们回顾性分析了符合标准的 21 例患者。16 例患者初次发生 pilon 骨折，5 例患者发生 Weber 分型 C 型踝关节骨折。我们进行了前胫骨远端距骨平台成形术以解决距骨的前移位和前塌陷。我们使用美国矫形足踝协会（AOFAS）后足评分和视觉模拟评分（VAS）作为临床结果。我们评估了术前和术后的外侧距骨位（LTS）、胫骨外侧表面（TLS）角、胫骨前表面角和距下关节角。我们使用改良 Kellgren-Lawrence 评分评估矢状面踝关节 OA。手术时的平均年龄为 35 岁，平均随访时间为 34 个月。AOFAS 后足评分从 26 分提高到 71 分（p<0.01），VAS 评分从 7 分改善至 2 分（p<0.01）。LTS 从 9.0 毫米改善至 2.3 毫米（p<0.01），TLS 角从 72°改善至 81°（p<0.01）。21 例患者中，18 例在矢状面显示 OA 改善或无恶化，3 例发生进展性踝关节 OA。通过前胫骨远端距骨平台成形术可获得关节面匹配的踝关节。这是治疗创伤性距骨前移位性踝关节炎的一种有价值的治疗选择。
