使用骨移植替代物进行经皮踝关节融合后的临床结果
Clinical Outcomes Following Percutaneous Ankle Fusion With Bone Graft Substitute.
作者信息
Marciano Gerard F, Ferlauto Harrison R, Confino Jamie, Kelly Meghan, Surace Michele F, Vulcano Ettore
机构信息
Department of Orthopedics, Columbia University Medical Center, New York, NY, USA.
Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
出版信息
Foot Ankle Orthop. 2023 Jun 11;8(2):24730114231178781. doi: 10.1177/24730114231178781. eCollection 2023 Apr.
BACKGROUND
Percutaneous ankle fusion is an emerging technique with minimal published outcome data. The goal of the present study is to retrospectively review clinical and radiographic outcomes following percutaneous ankle fusion and provide technique tips to perform percutaneous ankle fusion.
METHODS
Patients >18 years of age, treated by a single surgeon, from February 2018 to June 2021, who underwent primary isolated percutaneous ankle fusion supplemented with platelet-derived growth factor B (rhPDGF-BB) and beta-tricalcium phosphate, with at least 1-year follow-up were included. Surgical technique consisted of percutaneous ankle preparation followed by fixation with 3 headless compression screws. Pre- and postoperative visual analog scale (VAS) and Foot Function Index (FFI) were compared using paired tests. Fusion was assessed radiographically by the surgeon on postoperative radiographs and computed tomography (CT) at 3 months postoperatively.
RESULTS
Twenty-seven consecutive adult patients were included in the study. Mean follow-up was 21 months. Mean age was 59.8 years. Mean preoperative and postoperative VAS scores were 7.4 and 0.2, respectively ( < .01). Mean preoperative FFI pain domain, disability domain, activity restriction domain, and total score were 20.9, 16.7, 18.5, and 56.4, respectively. Mean postoperative FFI pain domain, disability domain, activity restriction domain, and total score were 4.3, 4.7, 6.7, and 15.8, respectively ( < .01). Fusion was achieved in 26 of 27 patients (96.3%) at 3 months. Four patients (14.8%) had complications.
CONCLUSION
We found in this cohort with surgery performed by a surgeon highly experienced in minimally invasive surgery that percutaneous ankle fusion augmented with a bone graft supplement achieved a high rate of fusion (96.3%) and a significant improvement in pain and function postoperatively while associated with minimal complications.
LEVEL OF EVIDENCE
Level IV, case series.
背景
经皮踝关节融合术是一种新兴技术，已发表的疗效数据极少。本研究的目的是回顾性分析经皮踝关节融合术后的临床和影像学结果，并提供经皮踝关节融合术的技术要点。
方法
纳入2018年2月至2021年6月期间由同一位外科医生治疗的年龄大于18岁的患者，这些患者接受了初次单纯经皮踝关节融合术，并补充了血小板衍生生长因子B（rhPDGF-BB）和β-磷酸三钙，且至少随访1年。手术技术包括经皮踝关节准备，然后用3枚无头加压螺钉固定。使用配对检验比较术前和术后视觉模拟量表（VAS）和足部功能指数（FFI）。术后3个月，由外科医生在术后X线片和计算机断层扫描（CT）上对融合情况进行影像学评估。
结果
本研究共纳入27例成年患者。平均随访时间为21个月。平均年龄为59.8岁。术前和术后VAS评分的平均值分别为7.4和0.2（<0.01）。术前FFI疼痛领域、残疾领域、活动受限领域和总分的平均值分别为20.9、16.7、18.5和56.4。术后FFI疼痛领域、残疾领域、活动受限领域和总分的平均值分别为4.3、4.7、6.7和15.8（<0.01）。27例患者中有26例（96.3%）在术后3个月实现了融合。4例患者（14.8%）出现并发症。
结论
在这个由一位在微创手术方面经验丰富的外科医生进行手术的队列中，我们发现补充骨移植的经皮踝关节融合术实现了较高的融合率（96.3%），术后疼痛和功能有显著改善，且并发症极少。
证据级别
IV级，病例系列。
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