Guerra Álvarez O, García Cruz G, Trinidad Leo A, de la Rubia Marcos A, Ruiz-Andreu Ortega J M, Rodrigo Verguizas J A
Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Segovia, Segovia, España.
Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial de Segovia, Segovia, España.
Rev Esp Cir Ortop Traumatol. 2022 Mar-Apr;66(2):105-112. doi: 10.1016/j.recot.2021.07.007. Epub 2021 Dec 1.
Arthroscopic tibiotalocalcaneal arthrodesis with a retrograde nail is performed as a minimally invasive technique in patients without improvement in conservative treatment of osteoarthritis. Complications and hospital stay after surgery are less using this technique when they are compared with open ones.
We review retrospectively from 2016 to 2019 seven patients subjected to a posterior arthroscopic tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. AOFAS scale was used to assess functional results and we collected other data as complications, time required for bony union, time of nonweight-bearing and scale of satisfaction. We also made a description of the technique we performed.
The mean hospital stay was 3.43±0.53 days, patients have well functional results and complications were very low. It was noticed tibiotalar bony union in about 86% of patients 10 weeks after surgery and subtalar bony union in about 71% 20 weeks after surgery. Nonweight-bearing was made using a cast for 4 weeks and later, it was changed for Walker allowing patients partial weight-bearing until 10 weeks after surgery. One patient had wound complications and he needed later surgery and another presented tibiotalar pseudoarthrosis, although without symptoms.
Posterior arthroscopic tibiotalocalcaneal arthrodesis offers very good results with a high rate of bony union, few complications, and minimal nonweight-bearing time. This technique could be used in patients without major deformities, especially in those at high risk of complications from the surgical wound.
对于骨关节炎保守治疗无改善的患者，采用逆行髓内钉进行关节镜下胫距跟关节融合术是一种微创技术。与开放手术相比，使用该技术术后并发症更少，住院时间更短。
我们回顾性分析了2016年至2019年期间7例行关节镜下后路胫距跟关节融合术并使用逆行髓内钉的患者。采用美国足踝外科协会（AOFAS）评分评估功能结果，并收集其他数据，如并发症、骨愈合所需时间、非负重时间和满意度评分。我们还对所采用的技术进行了描述。
平均住院时间为3.43±0.53天，患者功能结果良好，并发症发生率很低。术后10周约86%的患者胫距关节实现骨愈合，术后20周约71%的患者距下关节实现骨愈合。使用石膏固定4周进行非负重，之后更换为助行器，允许患者部分负重直至术后10周。1例患者出现伤口并发症，后来需要再次手术，另1例出现胫距关节假关节形成，不过没有症状。
关节镜下后路胫距跟关节融合术效果良好，骨愈合率高，并发症少，非负重时间短。该技术可用于无严重畸形的患者，尤其是手术伤口并发症风险高的患者。
