单一切口与双切口入路行双后足关节融合术：关节准备是否有差异？
Single Medial vs 2-Incision Approach for Double Hindfoot Arthrodesis: Is There a Difference in Joint Preparation?
机构信息
Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, USA.
Summit Orthopedics, St Paul, MN, USA.
出版信息
Foot Ankle Int. 2021 Aug;42(8):1068-1073. doi: 10.1177/10711007211001030. Epub 2021 Jun 13.
BACKGROUND
Double hindfoot arthrodesis is a reliable treatment option in lower extremity deformity and arthritis. Single (medial) and 2-incision techniques have been described. The purpose of this study was to evaluate the extent of cartilage debrided in each approach and to evaluate the competency of the deltoid ligament.
METHODS
Eight matched pairs of cadaveric specimens were acquired. One limb from each pair was randomly assigned to the single medial incision and the other to the 2-incision technique. Stress radiographs were obtained prior to dissection to evaluate for valgus tibiotalar tilt. The talonavicular and subtalar articular surfaces were denuded of cartilage and the joints disarticulated. The percentage of cartilage debrided was determined using ImageJ software. Postoperative tibiotalar tilt was measured with a technique and threshold previously described by our group. The intraclass correlation coefficient was calculated to determine inter- and intraobserver reliability.
RESULTS
The single medial incision demonstrated significantly less cartilage denuded than the 2-incision technique at the talar head (61.1% ± 20.4% vs 88.1% ± 6.1%, < .001), and the posterior facets of the talus (53.5% ± 7.6% vs 73.6% ± 7.0%, < .001) and calcaneus (55.3% ± 16.5% vs 81.0% ± 7.4%, = .001). Overall, 75% of specimens that underwent a single medial incision approach demonstrated increased valgus tibiotalar tilt postdissection, whereas none that underwent the 2-incision technique developed increased tibiotalar tilt ( < .01). The average tibiotalar tilt among these specimens was 4.6 ± 1.3 degrees (range 2.5-5.7 degrees). For all measurements, the intraclass correlation coefficient was greater than 0.8.
CONCLUSION
The posterior facet of the subtalar joint and talar head are at risk of subtotal debridement, as well as increased tibiotalar tilt with the single medial incision technique. Adequate debridement may require greater soft tissue dissection, possibly at the expense of medial ankle stability.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
背景
双后足踝关节融合术是治疗下肢畸形和关节炎的可靠方法。已经描述了单（内侧）和双切口技术。本研究的目的是评估每种方法切除的软骨量，并评估三角韧带的功能。
方法
获取 8 对匹配的尸体标本。每对标本的一条肢体被随机分配到单内侧切口组，另一条分配到双切口技术组。在解剖前获得应力射线照片，以评估内翻距骨倾斜。距骨和跟骨关节面的软骨被清除，关节脱臼。使用 ImageJ 软件确定切除的软骨百分比。使用我们小组先前描述的技术和阈值测量术后距骨倾斜。计算组内相关系数以确定组内和组间的可靠性。
结果
与双切口技术相比，单内侧切口组在距骨头部（61.1%±20.4%比 88.1%±6.1%，<0.001）和距骨后关节面（53.5%±7.6%比 73.6%±7.0%，<0.001）以及跟骨（55.3%±16.5%比 81.0%±7.4%，<0.001）的软骨切除量明显较少。总体而言，75%接受单内侧切口入路的标本在解剖后出现内翻距骨倾斜增加，而接受双切口技术的标本无一例出现距骨倾斜增加（<0.01）。这些标本的平均距骨倾斜角度为 4.6±1.3 度（范围 2.5-5.7 度）。对于所有测量值，组内相关系数均大于 0.8。
结论
单内侧切口技术可能会导致距骨后关节面和距骨头部的软骨部分切除，以及距骨倾斜增加。充分的清创可能需要更大的软组织解剖，可能会以牺牲内踝稳定性为代价。
证据等级
III 级，回顾性队列研究。
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