Cossins Charlotte, George Ben, Talia Adrian J, Loizou Constantinos, Kendal Adrian
Nuffield Orthopaedic Centre, Oxford, United Kingdom.
Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Footscray, Australia.
Foot Ankle Orthop. 2024 May 7;9(2):24730114241247547. doi: 10.1177/24730114241247547. eCollection 2024 Apr.
Tibiocalcaneal arthrodesis (TCA) can be achieved by internal fixation (intramedullary nail or plate), external fixation, or a combination. Evidence for the optimal approach is limited. This systematic review examines the outcomes of these different approaches to guide surgical management.
A MEDLINE and Oxford SOLO search was performed using "tibiocalcaneal," "ankle," "fusion OR arthrodesis." The primary outcome was union. Secondary outcomes included rates of postoperative complications, weightbearing status, rates of revision surgery, and PROMs. We included any studies with follow-up greater than 6 months that contained our primary outcome and at least 1 secondary outcome.
The initial search yielded 164 articles, of which 9 studies totaling 53 cases met the criteria. The majority of articles were excluded because they were nonsurgical studies, or were not about isolated TCA but were for tibiotalocalcaneal arthrodesis, more complex reconstructions (eg, Charcot), case reports, and/or did not include the predetermined outcome measures.TCA union rate was 86.2% following external fixation, 82.4% for intramedullary nail fixation, and 83.3% for plate fixation. One patient underwent a hybrid of external and internal fixation, and the outcome was nonunion. The rate of complications following TCA was 69.8%.
There is limited evidence on the best operative approach for isolated tibiocalcaneal arthrodesis. Both external and internal fixation methods had comparable union rates. External fixation had frequent complications and a more challenging postoperative protocol. Novel techniques such as 3D-printed cages and talus replacement may become a promising alternative but require further investigation.
胫跟关节融合术（TCA）可通过内固定（髓内钉或钢板）、外固定或两者结合来实现。关于最佳手术方法的证据有限。本系统评价旨在研究这些不同方法的治疗效果，以指导手术管理。
使用“胫跟”“踝关节”“融合术或关节固定术”在MEDLINE和牛津SOLO数据库进行检索。主要结局指标为骨愈合。次要结局指标包括术后并发症发生率、负重情况、翻修手术率和患者报告结局测量（PROMs）。我们纳入了随访时间超过6个月、包含主要结局指标且至少有1项次要结局指标的任何研究。
初步检索得到164篇文章，其中9项研究共53例符合标准。大多数文章被排除，原因包括它们是非手术研究、不是关于单纯胫跟关节融合术而是胫距跟关节融合术、更复杂的重建手术（如夏科氏关节病）、病例报告，和/或未包括预定的结局指标。外固定后胫跟关节融合率为86.2%，髓内钉固定为82.4%，钢板固定为83.3%。1例患者接受了外固定与内固定相结合的手术，结果为骨不连。胫跟关节融合术后并发症发生率为69.8%。
关于单纯胫跟关节融合术的最佳手术方法的证据有限。外固定和内固定方法的融合率相当。外固定并发症频繁，术后方案更具挑战性。3D打印融合器和距骨置换等新技术可能成为一种有前景的替代方法，但需要进一步研究。
