Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, P.R. China.
Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, P.R. China.
J Foot Ankle Surg. 2022 Mar-Apr;61(2):434-437. doi: 10.1053/j.jfas.2021.02.018. Epub 2021 Nov 16.
It is technical demanding work to perform arthroscopic ankle arthrodesis to treat end-stage ankle osteoarthritis with excessive talar tilt. This article aimed to provide an effective technique tip for the treatment of Takakura stage 3b ankle osteoarthritis with a talar tilt angle more than 15 degrees under arthroscopy. A conventional anterior arthroscopic approach is used. After arthroscopic examination and debridement, one pin which is parallel to the distal tibial surface is inserted into the tibial side of the ankle, the other pin which is parallel to the talar dome surface is inserted into the talar side of the ankle, both at the coronal plane. Then a distracter is used in the medial side to open the interspace of the tibiotalar joint and correct the talar tilt through the 2 pins, under which circumstance the tibiotalar joint surface can be well prepared. Next an anti-distracter is used in the lateral side to close the tibiotalar interspace and correct the talar tilt through the 2 pins, in which condition 3 fully threaded cannulated lag screws can be inserted through guide pins in a cross pattern to fix the ankle joint. We used the pin-based distracter to open and close tibiotalar interspace, correct the talar tilt and maintain a good mechanical axis for fusion, and the outcomes were good.
经关节镜下踝融合术治疗伴有距骨倾斜过大的终末期踝关节骨关节炎是一项技术要求较高的工作。本文旨在为关节镜下距骨倾斜超过 15 度的 Takakura 3b 期踝关节骨关节炎提供一种有效的治疗技术要点。采用常规前侧关节镜入路。关节镜检查和清创后，在冠状面将 2 枚平行于胫骨表面的钢针分别插入踝关节胫骨侧和距骨侧，然后在内侧使用牵开器撑开距下关节间隙，通过 2 枚钢针纠正距骨倾斜，此时可充分准备距下关节面。接下来在外侧使用抗牵开器闭合距下关节间隙，通过 2 枚钢针纠正距骨倾斜，在此情况下可以通过导针交叉插入 3 枚全螺纹空心加压螺钉固定踝关节。我们使用基于钢针的牵开器来撑开和闭合距下关节间隙、纠正距骨倾斜，并维持融合的良好力学轴线，取得了良好的效果。
