翻修失败的关节成形术后采用髂后自体骨进行胫距关节融合术：与初次踝关节融合术的匹配对照研究。

Revision tibiotalar arthrodesis with posterior iliac autograft after failed arthroplasty: A matched comparative study with primary ankle arthrodeses.

机构信息

Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France.

出版信息

Orthop Traumatol Surg Res. 2022 Nov;108(7):103269. doi: 10.1016/j.otsr.2022.103269. Epub 2022 Mar 11.

DOI:10.1016/j.otsr.2022.103269

PMID:35288327

Abstract

INTRODUCTION

Tibiotalar arthrodeses performed after failed ankle arthroplasties are known to be complex procedures with often disappointing functional outcomes. This study reports the results of a revision technique using a posterior iliac crest autograft.

HYPOTHESES

We hypothesized that: (1) revision tibiotalar arthrodeses (RTTAs) had functional outcomes which were similar to those of a reference cohort of primary tibiotalar arthrodeses (TTAs) and that (2) the union rate was satisfactory.

MATERIALS AND METHODS

This retrospective study compared 16 RTTAs performed for failed arthroplasties that caused pain and a functional disability (4 aseptic loosening, 4 massive progressive periprosthetic cysts, 5 malpositioning of implants, and 3 cases of unexplained mechanical pain) with a series of 16 primary TTAs performed for painful ankle osteoarthritis. The groups were matched at a 1:1 ratio for age, sex, side and body mass index. The preoperative workup included a physical exam, the American Orthopaedic Foot and Ankle Society (AOFAS) score, weight bearing radiographs, CT and SPECT scans. Outcomes were assessed both clinically (AOFAS score) and radiographically (X-rays and scans). The mean duration of the procedure (DP), average length of stay (LOS), fusion and complication rates, and time to union were also compared.

RESULTS

At the mean follow-up of 30 months (range, 12-88) for the RTTA group and 59 months (range, 23-94) for the TTA group (p=.001), the AOFAS score increased from 27 to 70.8 points (p<.001) and from 29.8 to 76.2 points (p<.001), respectively; values were similar at the last follow-up (p=.442). Both groups had similar fusion (94%) and complication rates (12%). The DP was 196.9±33.6min (range, 179-213) vs. 130±28.4min (range, 118-141) (p<.001) and the LOS was 3.8 days (range, 2-6) vs. 3.9 days (range, 2-6) (p<.445) for both groups (RTTA vs. TTA).

CONCLUSION

This RTTA technique using a posterior iliac crest allograft for filling bone defects was validated by the quality of the functional outcomes obtained.

LEVEL OF EVIDENCE

IV; Comparative retrospective study.

摘要

介绍

踝关节置换术后翻修的距下关节融合术是一种复杂的手术，其功能结果往往令人失望。本研究报告了一种使用髂后嵴自体移植物进行翻修的技术结果。

假说

我们假设：（1）翻修的距下关节融合术（RTTA）的功能结果与原发性距下关节融合术（TTA）的参考队列相似；（2）融合率令人满意。

材料和方法

本回顾性研究比较了 16 例因假体松动、大量进行性假体周围囊肿、假体位置不当和 3 例不明原因机械性疼痛而导致疼痛和功能障碍的踝关节置换术后翻修的 RTTAs 与 16 例因疼痛性踝关节骨关节炎而进行的原发性 TTA。两组按年龄、性别、侧别和体重指数 1:1 配对。术前检查包括体格检查、美国矫形足踝协会（AOFAS）评分、负重 X 线片、CT 和 SPECT 扫描。结果通过临床（AOFAS 评分）和影像学（X 线片和扫描）进行评估。还比较了手术程序的平均持续时间（DP）、平均住院时间（LOS）、融合和并发症发生率以及愈合时间。

结果

在 RTTA 组的平均随访 30 个月（范围 12-88）和 TTA 组的平均随访 59 个月（范围 23-94）时（p=.001），AOFAS 评分分别从 27 分增加到 70.8 分（p<.001）和从 29.8 分增加到 76.2 分（p<.001）；在最后一次随访时，两组的评分相似（p=.442）。两组的融合率（94%）和并发症发生率（12%）相似。DP 分别为 196.9±33.6min（范围 179-213）和 130±28.4min（范围 118-141）（p<.001）， LOS 分别为 3.8 天（范围 2-6）和 3.9 天（范围 2-6）（p<.445）（RTTA 与 TTA）。