Yokoo Suguru, Saiga Kenta, Demiya Koji, Ohashi Hideki, Horita Masahiro, Ozaki Toshifumi
Department of Orthopaedic Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
Department of Orthopaedic Surgery, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama, 701-1192, Japan.
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1557-1563. doi: 10.1007/s00590-022-03307-x. Epub 2022 Jun 22.
Arthroscopic ankle arthrodesis (AAA) has risks of complications, such as delayed union and non-union. The number and direction of the inserted screws have been reported as important factors affecting the time to union of AAA. However, the ratio of inter-screw distance (ISD) to tibial width (TW) in different planes has not been investigated. Therefore, we aimed to explore the effect of this ratio on bone union following AAA.
We retrospectively enrolled 63 patients (64 ankles) undergoing AAA from 2013 to 2019. Then, their age, body mass index (BMI), sex, diabetes mellitus (DM) status, Takakura-Tanaka classification, number of screws and radiographic parameters were analysed.
The patients had a mean age of 70.3 (range, 45-91) years. Bone fusion was achieved in 57 ankles (89%) in a mean period of 3.3 (range, 2-6) postoperative months. There were four cases of delayed union and three of non-union. No significant differences in age, BMI, sex, DM, Takakura-Tanaka classification, and number of screws could be detected between the groups. However, the sagittal ISD/TW ratio was significantly larger in the union group than in the delayed/non-union group with a cut-off value of 57.0%.
Larger sagittal ISD/TW ratios result in reduced post-AAA delayed union or non-union. The surgeon should be aware that the anterior and posterior screw widths should be approximately 60% or more of the anteroposterior width of the tibia.
关节镜下踝关节融合术（AAA）存在并发症风险，如骨愈合延迟和骨不连。已报道所植入螺钉的数量和方向是影响AAA骨愈合时间的重要因素。然而，不同平面的螺钉间距（ISD）与胫骨宽度（TW）的比例尚未得到研究。因此，我们旨在探讨该比例对AAA术后骨愈合的影响。
我们回顾性纳入了2013年至2019年期间接受AAA手术的63例患者（64个踝关节）。然后，分析了他们的年龄、体重指数（BMI）、性别、糖尿病（DM）状态、高仓 - 田中分类、螺钉数量和影像学参数。
患者的平均年龄为70.3岁（范围45 - 91岁）。57个踝关节（89%）在术后平均3.3个月（范围2 - 6个月）实现了骨融合。有4例骨愈合延迟和3例骨不连。两组之间在年龄、BMI、性别、DM、高仓 - 田中分类和螺钉数量方面未检测到显著差异。然而，愈合组的矢状面ISD/TW比例显著大于延迟/不愈合组，临界值为57.0%。
较大的矢状面ISD/TW比例可减少AAA术后的骨愈合延迟或骨不连。外科医生应注意前后螺钉宽度应约为胫骨前后宽度的60%或更多。
