距手术10年及以上的全距骨置换长期临床结果
The Long-Term Clinical Results of Total Talar Replacement at 10 Years or More After Surgery.
作者信息
Morita Shigeki, Taniguchi Akira, Miyamoto Takuma, Kurokawa Hiroaki, Takakura Yoshiyuki, Takakura Yoshinori, Tanaka Yasuhito
机构信息
Department of Orthopedic Surgery, Nara Medical University, Kashihara, Japan.
Takakura Orthopedic Clinic, Kobe, Japan.
出版信息
J Bone Joint Surg Am. 2022 May 4;104(9):790-795. doi: 10.2106/JBJS.21.00922. Epub 2022 Feb 21.
BACKGROUND
Total talar replacement has been reported to have favorable short-term and intermediate-term results for the treatment of osteonecrosis of the talus. The purpose of this study was to evaluate the long-term clinical results of total talar replacement for a minimum of 10 years after the surgical procedure.
METHODS
From October 2005 to April 2011, 19 ankles in 18 patients (1 male and 17 female) were treated using a total talar prosthesis for osteonecrosis of the talus. The median follow-up period was 152 months (interquartile range [IQR], 138, 160 months). The Ankle Osteoarthritis Scale (AOS) score, the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale score, and the presence of osteophytes and degenerative changes in the adjacent joints were assessed preoperatively and at the final follow-up. Subsidence of the prosthesis was also assessed at the earliest opportunity for full weight-bearing and the final follow-up. The postoperative range of motion of the ankle was assessed at the final follow-up.
RESULTS
The median scores for all subscales of the AOS significantly improved. The median JSSF Ankle-Hindfoot Scale score significantly improved from 58 (IQR, 55, 59.5) to 97 (IQR, 87, 99.5). In the subcategories of this scale, the median pain score improved from 20 (IQR, 20, 20) to 40 (IQR, 30, 40), and the median function score improved from 28 (IQR, 26, 30.5) to 47 (IQR, 47, 50). The median postoperative range of motion of the ankle was 45° (IQR, 42.5°, 55°). Subsidence of the implant was not recognized at the final follow-up (p = 0.083). Proliferation of osteophytes and degenerative changes in the adjacent joints did not affect the overall results.
CONCLUSIONS
The customized alumina ceramic total talar prosthesis produced stable clinical outcomes over 10 years, and the patients treated with total talar replacement showed favorable clinical results over this time frame.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
据报道，距骨全置换术在治疗距骨坏死方面具有良好的短期和中期效果。本研究的目的是评估距骨全置换术后至少10年的长期临床效果。
方法
2005年10月至2011年4月，18例患者（1例男性和17例女性）的19个踝关节采用距骨全假体治疗距骨坏死。中位随访期为152个月（四分位间距[IQR]，138, 160个月）。术前和末次随访时评估踝关节骨关节炎量表（AOS）评分、日本足外科学会（JSSF）踝关节-后足量表评分以及相邻关节骨赘和退变改变的情况。在最早能够完全负重时和末次随访时评估假体的下沉情况。末次随访时评估术后踝关节活动范围。
结果
AOS所有子量表的中位评分均显著改善。JSSF踝关节-后足量表的中位评分从58（IQR，55, 59.5）显著提高到97（IQR，87, 99.5）。在该量表的子类别中，中位疼痛评分从20（IQR，20, 20）提高到40（IQR，30, 40），中位功能评分从28（IQR，26, 30.5）提高到47（IQR，47, 50）。术后踝关节活动范围的中位值为45°（IQR，42.5°，55°）。末次随访时未发现植入物下沉（p = 0.083）。相邻关节的骨赘增生和退变改变未影响总体结果。
结论
定制的氧化铝陶瓷距骨全假体在10年以上产生了稳定的临床结果，接受距骨全置换术治疗的患者在此时间段内显示出良好的临床效果。
证据水平
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
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