Department of Orthopaedic Surgery, Armed Forces Yangju Hospital, Yangju, Korea.
Department of Orthopaedic Surgery, Sree Narayana Institute of Medical Sciences, Ernakulam, India.
Clin Orthop Surg. 2024 Aug;16(4):636-640. doi: 10.4055/cios24003. Epub 2024 Jun 26.
Ankle fusion is considered a treatment of choice for end-stage ankle arthritis when a total ankle replacement procedure is not indicated. However, the potential risk of secondary arthritis in the adjacent joint after ankle fusion raises arguments on whether preserving the adjacent joint during an isolated tibiotalar (TT) fusion brings about any future benefits with regard to pain and gait discomfort. In this study, we intended to present midterm results following TT or tibiotalocalcaneal (TTC) fusion using an Ilizarov external fixator and to investigate whether spontaneous fusion occurred in the subtalar or midtarsal joint.
This is a retrospective observational study. Medical records of patients who underwent TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint between 1994 and 2018 were manually searched. Forty-one patients were included and the status of the joints adjacent to the fusion site was evaluated in radiographic examinations.
Of the 34 patients who underwent TT fusion, 30 patients (88.3%) had a spontaneous fusion in the adjacent joints. Specifically, 11 patients (29.4%) had subtalar joint fusion and 19 patients (55.9%) had both midtarsal joint and subtalar joint fusion. In TTC fusion, the midtarsal joint was spontaneously fused in all 7 patients.
In this study, we observed spontaneous adjacent joint fusion following TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint. Although a careful approach should be made since patients treated in this study may not represent typical candidates that need primary joint-sacrificing procedures, we believe that this study may draw attention from surgeons concerned about the fate of the adjacent joint status after TT or TTC fusion.
当全踝关节置换术不适用时，踝关节融合术被认为是治疗终末期踝关节关节炎的首选方法。然而，踝关节融合术后相邻关节继发关节炎的潜在风险引发了争议，即在单纯距下关节（TT）融合术中保留相邻关节是否会在疼痛和步态不适方面带来任何未来的益处。在这项研究中，我们旨在展示使用伊利扎罗夫外固定架进行 TT 或距下跟骨（TTC）融合术后的中期结果，并研究距下或中跗关节是否会自发融合。
这是一项回顾性观察性研究。手动搜索了 1994 年至 2018 年间使用伊利扎罗夫外固定架治疗踝关节周围严重骨缺损的 TT 或 TTC 融合术患者的病历。共纳入 41 例患者，并在影像学检查中评估融合部位相邻关节的状态。
在接受 TT 融合术的 34 例患者中，有 30 例（88.3%）相邻关节自发融合。具体而言，11 例（29.4%）患者出现距下关节融合，19 例（55.9%）患者出现中跗关节和距下关节融合。在 TTC 融合中，7 例患者的中跗关节均自发融合。
在这项研究中，我们观察到使用伊利扎罗夫外固定架治疗踝关节周围严重骨缺损的 TT 或 TTC 融合术后相邻关节自发融合。尽管由于本研究中治疗的患者可能不能代表需要进行初次关节牺牲手术的典型患者，因此应采取谨慎的方法，但我们认为，这项研究可能会引起关注关节融合术后相邻关节状态的外科医生的关注。
