Groth H E, Fitch H F
University of Oregon Medical School, Portland.
Clin Orthop Relat Res. 1987 Nov(224):244-50.
Total ankle arthroplasty (TAA) has been a satisfactory procedure with a low failure rate only when applied to the rheumatoid patient. For the active, posttraumatic patient, ankle joint fusion is superior and avoids the attendant high failure rate. In general, salvage of failed TAA is best solved by ankle fusion. Only in one of five cases (a compliant patient with a clear-cut correctable technical error) was a good result achieved with a revision arthroplasty. To maintain limb length, the authors transplanted iliac crest autogenic bone to fill a large defect. When tightly packed with bone, the joint is slightly distracted and compression enhances fusion. For septic loosening, osteotomy of the malleoli and fusion without grafting is recommended. Persistent pain unassociated with loosening an infection may be treated by removal of impingement of bone overgrowth. Soft tissue release to improve motion is rarely successful. Marginal skin slough was a problem in 8.5% of 71 cases. To facilitate healing, debridement of nonfunctional exposed tendons may be advisable.
全踝关节置换术（TAA）仅应用于类风湿患者时才是一种成功率较低但令人满意的手术。对于活跃的创伤后患者，踝关节融合术更具优势，且可避免随之而来的高失败率。一般来说，失败的TAA的挽救最好通过踝关节融合来解决。只有五分之一的病例（一位依从性好且存在明确可纠正技术错误的患者）通过翻修关节置换术取得了良好效果。为了保持肢体长度，作者移植了自体髂骨来填充大的骨缺损。当用骨紧密填充时，关节会稍有牵张，加压可促进融合。对于感染性松动，建议行踝关节截骨术且不植骨进行融合。与松动或感染无关的持续性疼痛可通过去除骨赘撞击来治疗。通过软组织松解来改善活动度很少成功。71例中有8.5%出现边缘皮肤溃疡问题。为促进愈合，对无功能的外露肌腱进行清创可能是可取的。
