Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Syndey Kimmel Medical College, Philadelphia, PA, USA.
Foot Ankle Int. 2022 Nov;43(11):1410-1418. doi: 10.1177/10711007221115182. Epub 2022 Sep 1.
Three-dimensional custom cages can be used to treat complex ankle and hindfoot pathology and bone loss with potentially better patient satisfaction and higher fusion rates than tibiotalocalcaneal (TTC) fusion alone or in combination with bulk femoral head allograft. Yet there is limited literature to support this procedure. The purpose of this study is to objectively quantify the clinical and radiologic outcomes of patients undergoing patient-specific 3D-printed custom cage implantation to fill large defects around the ankle joint region as part of a limb-salvaging TTC fusion.
This is a retrospective review of 21 patients (mean age 59.3 years) who underwent custom cage implantation with a TTC retrograde fusion nail by a single surgeon for massive bone loss of the ankle and hindfoot. Patient charts were reviewed for pain and functional outcomes, complications, and various demographics, including number of previous surgeries to the ipsilateral ankle. Mean follow-up was 32 months. All 21 patients had preoperative and postoperative pain and function scores available for analysis.
A total of 20 (95.2%) of the 21 patients had their cage in situ at final follow-up. Overall, with the numbers available, visual analog scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM) activities of daily living subscale, and the 12-Item Short Form Health Survey (SF-12) mental and physical health scores significantly improved from preoperative to final follow-up. However, when compared to the overall US population of age-matched 55- to 64-year-old individuals, patients still remained relatively disabled. There were 2 failures, one of which required amputation and the other was treated nonoperatively with bracing.
In conclusion, in this relatively small, single-surgeon series, we found that 3D-printed custom cage technology offered a viable option for complex TTC fusion procedures performed in the presence of significant bone loss, with good fusion rates, however relatively modest improvement in functional outcomes.
Level IV, retrospective case series.
三维定制笼可用于治疗复杂的踝关节和后足病理及骨丢失，与单纯的胫距跟（TTC）融合或与大块股骨头同种异体骨联合使用相比，患者满意度和融合率可能更高。然而，支持这种手术的文献有限。本研究的目的是客观量化接受特定于患者的 3D 打印定制笼植入以填充踝关节周围大缺陷的患者的临床和影像学结果，作为肢体挽救性 TTC 融合的一部分。
这是对 21 例（平均年龄 59.3 岁）接受定制笼植入和 TTC 逆行融合钉的患者进行的回顾性研究，这些患者均有严重的踝关节和后足骨丢失。对患者的图表进行了疼痛和功能结果、并发症和各种人口统计学数据（包括同侧踝关节的既往手术次数）的回顾。平均随访 32 个月。所有 21 例患者均有术前和术后疼痛和功能评分可供分析。
在最终随访时，共有 20 例（95.2%）患者的笼仍在原位。总体而言，在可获得的数量中，视觉模拟量表（VAS）疼痛评分、足踝能力测量（FAAM）日常生活活动子量表和 12 项简短健康调查（SF-12）心理健康和身体健康评分均从术前到最终随访显著改善。然而，与年龄匹配的 55 至 64 岁美国人群相比，患者仍然相对残疾。有 2 例失败，其中 1 例需要截肢，另 1 例经非手术支具治疗。
总之，在这项相对较小的、由单名外科医生进行的系列研究中，我们发现 3D 打印定制笼技术为存在严重骨丢失的复杂 TTC 融合手术提供了可行的选择，融合率较高，但功能结果的改善相对较小。
IV 级，回顾性病例系列。
