Li Jia, Wu Shizhou, Gan Tingjiang, Qin Boquan, Yin Shijiu, Zhang Hui
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jul 15;37(7):802-809. doi: 10.7507/1002-1892.202306040.
To investigate the short-term effectiveness of INBONE Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis.
The clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONE Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, =34) and a severe varus group (group B, TTA>15°, =24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups ( >0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences ( <0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared.
All patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased ( <0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased ( <0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up ( <0.05); but there was no significant difference in plantarflexion range of motion ( >0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups ( >0.05); there was a significant difference in the difference of other radiographic parameters ( <0.05) except TLS. No significant difference in the incidence of complications between the two groups was found ( >0.05).
TAA using the INBONE Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.
探讨INBONEⅡ全踝关节置换术治疗中重度内翻型踝关节关节炎的短期疗效。
回顾性分析2017年5月至2021年11月收治的采用INBONEⅡ假体行全踝关节置换术（TAA）治疗的中重度内翻型踝关节关节炎患者的临床及影像学资料。共有58例患者（58个踝关节）符合入选标准并纳入研究。其中，男性24例，女性34例，平均年龄62.6岁（范围41 - 85岁）。根据术前胫距角（TTA），将患者分为中度内翻组（A组，TTA 5° - 15°，n = 34）和重度内翻组（B组，TTA>15°，n = 24）。两组患者在性别、患侧、病因、术前美国矫形足踝协会（AOFAS）评分、踝关节背屈、跖屈及总活动度、胫骨外侧表面角（TLS）方面差异均无统计学意义（P>0.05）。但A组患者年龄小于B组，骨关节炎程度（Takakura分期）及踝关节疼痛[视觉模拟评分（VAS）]较轻，TTA、距骨倾斜角（TT）、后足对线角（HAA）较小，而胫骨关节面角（TAS）较大，差异有统计学意义（P<0.05）。记录并比较患者术前及术后的VAS评分、AOFAS评分、早期及晚期并发症发生情况、踝关节影像学参数（TTA、TAS、TT、HAA、TLS）、踝关节背屈、跖屈及总活动度。
所有患者均获随访19 - 72个月，平均38.9个月。与术前数据相比，所有患者的VAS评分显著降低（P<0.05）；AOFAS评分、踝关节背屈活动度及总活动度显著增加（P<0.05）；末次随访时TTA、TAS、TT、HAA及TLS显著改善（P<0.05）；但跖屈活动度差异无统计学意义（P>0.05）。13例患者发生早期并发症，仅1例因距骨假体尺寸较大行翻修手术。末次随访时两组患者手术前后临床参数差值差异无统计学意义（P> .05）；除TLS外其他影像学参数差值差异有统计学意义（P<0.05）。两组并发症发生率差异无统计学意义（P>0.05）。
采用INBONEⅡ全踝关节假体行TAA是治疗中重度内翻型踝关节关节炎的有效方法，可获得良好的临床及影像学效果。矫正骨畸形及平衡软组织是手术成功的关键。
