Director, Paley Orthopedic & Spine Institute, West Palm Beach, FL.
Chief of Foot and Ankle Surgery at St. Mary's Medical Center and The Palm Beach Children's Hospital, Director, Foot and Ankle Deformity Center and Fellowship at Paley Orthopedic & Spine Institute, West Palm Beach, FL.
J Foot Ankle Surg. 2022 Jul-Aug;61(4):e15-e20. doi: 10.1053/j.jfas.2021.11.020. Epub 2021 Dec 4.
We reviewed 18 limbs in 17 patients who underwent ankle fusion with simultaneous tibial lengthening with a magnetic internal lengthening nail. All patients had preoperative limb length discrepancy (LLD) (mean 4.9 cm (2.6-7.6 cm)) with ankle deformity. The ankle was fused from medial or lateral approaches using screws/plate constructs placed adjacent to the retrograde Precise nail. Lengthening was carried out by a distal 1/3 tibial osteotomy. Clinical and radiographic measures were performed after a mean follow-up of 20 months (12-37 months). The mean amount of lengthening performed was 4 cm (1.8-7.2 cm). The final mean LLD was 1 cm (0.7-1.1 cm), which was statistically significant (p<0.01) as compared to preoperative. The foot was plantigrade in all cases. The mean foot rotation was 10° (5-15°) external, relative to the knee. At final follow-up all patients reported minimal to no pain, and all claimed to be walking more functionally than before surgery. Ankle fusion and limb lengthening was achieved in all cases. Combining both treatments by using an internal lengthening nail was very effective and avoided leaving patients with a dysfunctional LLD or of having a separate limb lengthening procedure. This is the first report of such a combined treatment of ankle fusion with internal tibial lengthening nail.
我们回顾了 17 名患者的 18 条肢体，这些患者接受了带磁内延长钉的踝关节融合术和同时进行的胫骨延长术。所有患者术前均存在肢体长度差异（LLD）（平均 4.9 厘米（2.6-7.6 厘米））和踝关节畸形。踝关节通过内侧或外侧入路，使用放置在逆行 Precise 钉附近的螺钉/板结构融合。通过胫骨远端 1/3 处的截骨进行延长。平均随访 20 个月（12-37 个月）后进行临床和影像学测量。平均延长长度为 4 厘米（1.8-7.2 厘米）。最终平均 LLD 为 1 厘米（0.7-1.1 厘米），与术前相比有统计学意义（p<0.01）。所有病例足部均为跖行。足部旋转平均为 10°（5-15°），相对于膝关节向外。在最终随访时，所有患者报告疼痛轻微或无疼痛，并且都声称比手术前更能正常行走。所有病例均成功实现了踝关节融合和肢体延长。通过使用内置延长钉同时进行这两种治疗非常有效，避免了患者出现功能失调的 LLD 或需要进行单独的肢体延长手术。这是首例报告踝关节融合术与内置胫骨延长钉联合治疗的病例。
