冠状面畸形程度和患者相关因素是否影响关节镜下与开放踝关节融合术的愈合和结果？
Do degree of coronal plane deformity and patient related factors affect union and outcome of Arthroscopic versus Open Ankle Arthrodesis?
机构信息
Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
出版信息
Foot Ankle Surg. 2022 Jul;28(5):635-641. doi: 10.1016/j.fas.2021.07.010. Epub 2021 Jul 24.
BACKGROUND
This study aimed to analyse if union and outcome of Arthroscopic Ankle Arthrodesis (AAA) versus Open Ankle Arthrodesis (OAA) were influenced by the extent of coronal plane deformity and to report if patient related factors influence union.
METHODS
A total of 122 ankle arthrodesis procedures were included in the study. These were divided into two groups; Group A (n = 99) with deformity less than 15° and Group B (n = 23) with deformity greater than or equal to 15°. Data was collected on patient demographics, medical comorbidities (smoking, diabetes, obesity) and time to union. Patient reported outcome measures (PROMs) evaluated were Manchester Oxford Foot Questionnaire, EuroQol-5D and EuroQol visual analogue health thermometer (EQ-VAS).
RESULTS
The mean follow-up in Group A and B was 74.87 and 89.17 months respectively. The average deformity in Group A was 4.9° for AAA and 5.8° for OAA. In Group B it was 18.9° (maximum 28° varus) for AAA and 22.1° (maximum 41° valgus) for OAA. The overall union rate was 95% in Group A (AAA-94%; OAA-100%; [p = 0.20]) and 87% in Group B (AAA-100%; OAA-67%; [p = 0.02]). Mean time to union was 13.2 weeks in Group A (AAA-13.3 weeks; OAA-12.8 weeks; [p = 0.73]) compared to 12.4 weeks for Group B (AAA-12.9 weeks; OAA-11.8 weeks; [p = 0.56]). Irrespective of the extent of deformity and type of surgery, smokers had a 10 times higher likelihood of non-union (p = 0.03). In Group A, none of the PROMs showed significant difference between AAA and OAA. In Group B, EQ-VAS score reached statistical significance (p = 0.03) in favour of AAA whereas other PROMs showed no difference.
CONCLUSION
AAA is reproducible in achieving union in end stage ankle arthritis and good PROMs can be expected even in ankles with larger deformities. Regardless of the type of surgery and extent of deformity, smoking is a significant risk factor for non-union.
LEVEL OF EVIDENCE
Level III, retrospective comparative series.
背景
本研究旨在分析关节镜下踝关节融合术（AAA）与开放式踝关节融合术（OAA）的融合结果是否受冠状面畸形程度的影响，并报告患者相关因素是否影响融合。
方法
共纳入 122 例踝关节融合术患者。将其分为两组；A 组（n=99）畸形小于 15°，B 组（n=23）畸形大于或等于 15°。收集患者人口统计学、合并症（吸烟、糖尿病、肥胖）和愈合时间的数据。评估的患者报告结局测量（PROMs）包括曼彻斯特牛津足部问卷、欧洲五维健康量表（EQ-5D）和欧洲五维健康量表视觉模拟健康温度计（EQ-VAS）。
结果
A 组和 B 组的平均随访时间分别为 74.87 和 89.17 个月。A 组的平均畸形为 4.9°（AAA）和 5.8°（OAA）。B 组为 18.9°（最大 28°内翻）（AAA）和 22.1°（最大 41°外翻）（OAA）。A 组总体愈合率为 95%（AAA-94%；OAA-100%；[p=0.20]），B 组为 87%（AAA-100%；OAA-67%；[p=0.02]）。A 组平均愈合时间为 13.2 周（AAA-13.3 周；OAA-12.8 周；[p=0.73]），B 组为 12.4 周（AAA-12.9 周；OAA-11.8 周；[p=0.56]）。无论畸形程度和手术类型如何，吸烟者发生不愈合的可能性是 10 倍（p=0.03）。在 A 组中，AAA 和 OAA 之间的任何 PROM 均无显著差异。在 B 组中，EQ-VAS 评分有统计学意义（p=0.03），有利于 AAA，而其他 PROM 则无差异。
结论
AAA 在治疗终末期踝关节关节炎时可达到愈合效果，即使在畸形较大的踝关节中，也可获得良好的 PROMs。无论手术类型和畸形程度如何，吸烟都是不愈合的一个显著危险因素。
证据水平
三级，回顾性比较系列。
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