University Medical Hospital Utrecht, Utrecht, The Netherlands.
University Medical Hospital Utrecht, Utrecht, The Netherlands.
J Foot Ankle Surg. 2022 May-Jun;61(3):609-614. doi: 10.1053/j.jfas.2021.10.022. Epub 2021 Oct 22.
Fusion remains the gold standard for post-traumatic osteoarthritis after ankle fractures in many institutes. Patient-reported outcomes on long-term quality of life and functionality of talocrural arthrodesis remain relatively unknown. In literature, low patient numbers and inadequate outcome measures provide a poor foundation for patient expectation management. Additionally, the surgical approach is often omitted. This study presents a retrospective cohort of patients who underwent open or arthroscopic talocrural arthrodesis for post-traumatic arthritis between 2008 and 2019 with prospective follow-up by questionnaire. Participants completed the EuroQol 5-dimensional 3-level questionnaire (EQ-5D-3L), EuroQol Visual Analogue Scale (EQ-VAS), Foot and Ankle Outcome Score Dutch Language Version (FAOS-DLV), and 4 additional questions. Thirty-five patients were included in the cohort and 32 were included for follow-up. Trauma mechanism was mainly a low fall or motor vehicle accident causing a talocrural fracture-dislocation in most cases. For open versus arthroscopic treatment respectively, patients reported a median EQ-5D-3L index of 0.775 and 0.775, EQ-VAS of 80 and 88, FAOS-DLV of 57.0 and 63.9, and satisfaction of 90 and 88 out of 100 after a median of 6.0 and 6.5 years. This study is unique as it is the largest series on patient-reported outcomes in patients with post-traumatic arthrosis with validated questionnaires. In general, patients were satisfied with relatively high questionnaire scores, especially concerning pain and daily living. These functional scores are of importance when setting patient expectations regarding talocrural arthrodesis and recovery. Additionally, the subscale values may help preoperatively in weighing the intervention's advantages and disadvantages for individual patients.
在许多机构中，融合仍然是踝关节骨折后创伤性骨关节炎的金标准。关于距下关节融合术长期生活质量和功能的患者报告结果仍然知之甚少。在文献中，患者数量少和评估结果不充分为患者期望管理提供了很差的基础。此外，手术入路通常被省略。本研究回顾性分析了 2008 年至 2019 年间因创伤性关节炎行开放或关节镜下距下关节融合术的患者队列，通过问卷调查进行前瞻性随访。参与者完成了欧洲五维健康量表 3 级问卷（EQ-5D-3L）、欧洲五维健康量表视觉模拟评分（EQ-VAS）、荷兰足踝结局评分（FAOS-DLV）和 4 个附加问题。35 例患者纳入队列，32 例患者纳入随访。创伤机制主要为低坠落或机动车事故，导致大多数情况下距下关节骨折脱位。在开放与关节镜治疗方面，患者报告的 EQ-5D-3L 指数中位数分别为 0.775 和 0.775，EQ-VAS 中位数分别为 80 和 88，FAOS-DLV 中位数分别为 57.0 和 63.9，满意度中位数分别为 90 和 88。在中位数为 6.0 年和 6.5 年后，这是一项独特的研究，因为它是使用验证问卷报告创伤后关节炎患者患者报告结果的最大系列研究。总的来说，患者对相对较高的问卷评分表示满意，尤其是对疼痛和日常生活。这些功能评分在确定距下关节融合术和康复的患者期望时非常重要。此外，亚量表值可能有助于术前权衡干预对个别患者的利弊。
