Callaghan Christopher J, McKinley John C
The University of Edinburgh, Edinburgh Medical School, Edinburgh, UK.
Bone Jt Open. 2021 Jul;2(7):503-508. doi: 10.1302/2633-1462.27.BJO-2021-0057.R1.
Arthroplasty has become increasingly popular to treat end-stage ankle arthritis. Iatrogenic posterior neurovascular and tendinous injury have been described from saw cuts. However, it is hypothesized that posterior ankle structures could be damaged by inserting tibial guide pins too deeply and be a potential cause of residual hindfoot pain.
The preparation steps for ankle arthroplasty were performed using the Infinity total ankle system in five right-sided cadaveric ankles. All tibial guide pins were intentionally inserted past the posterior tibial cortex for assessment. All posterior ankles were subsequently dissected, with the primary endpoint being the presence of direct contact between the structure and pin.
All pin locations confer a risk of damaging posterior ankle structures, with all posterior ankle structures except the flexor hallucis longus tendon being contacted by at least one pin. Centrally-aligned transcortical pins were more likely to contact posteromedial neurovascular structures.
These findings support our hypothesis that tibial guide pins pose a considerable risk of contacting and potentially damaging posterior ankle structures during ankle arthroplasty. This study is the first of its kind to assess this risk in the Infinity total ankle system. Cite this article: 2021;2(7):503-508.
关节成形术已越来越普遍地用于治疗终末期踝关节关节炎。锯切已导致医源性后神经血管和肌腱损伤。然而，据推测，胫骨导针插入过深可能会损伤踝关节后部结构，并成为残留后足疼痛的潜在原因。
使用Infinity全踝关节系统对5个右侧尸体踝关节进行踝关节成形术的准备步骤。所有胫骨导针均有意插入超过胫骨后皮质进行评估。随后对所有踝关节后部进行解剖，主要终点是结构与导针之间是否存在直接接触。
所有导针位置都有损伤踝关节后部结构的风险，除拇长屈肌腱外，所有踝关节后部结构至少被一根导针接触。中心对齐的经皮质导针更有可能接触后内侧神经血管结构。
这些发现支持了我们的假设，即胫骨导针在踝关节成形术期间有相当大的风险接触并可能损伤踝关节后部结构。本研究是首次在Infinity全踝关节系统中评估这种风险。引用本文：2021；2(7)：503-508。
