Boucly Joffrey, Bouché Pierre-Alban, Bermudo Gamboa Maria Dolores, Ménigaux Christophe, Hardy Alexandre, Bauer Thomas, Pioger Charles
Department of Orthopedic Surgery, Ambroise Paré Hospital, Boulogne-Billancourt, France.
Department of Orthopedic Surgery, Lariboisière Hospital, Paris, France.
Foot Ankle Int. 2024 Dec;45(12):1303-1309. doi: 10.1177/10711007241283803. Epub 2024 Oct 23.
Severe septic destruction of the ankle joint poses a therapeutic challenge but lacks a consensus optimal treatment. Tibiotalocalcaneal arthrodesis (TTCA) is considered a valuable salvage procedure, but the literature remains scarce. Conventional treatment approaches, including 2-stage procedures, have been associated with prolonged recovery times and varying success rates. Many authors prefer classical external fixation in these scenarios, citing concerns that internal implants might pose a risk for recurrent infection. To date, no study has investigated the outcomes of 1-stage surgery using a retrograde intramedullary (IM) nail. The main purpose was to assess the rate of recurrent infection at 2 years following 1-stage TTCA using a retrograde IM nail in severe septic destruction of the ankle joint. Fusion rates and functional outcomes were evaluated as secondary purposes.
The clinical and radiologic data of patients who underwent 1-stage TTCA with retrograde IM nail following severe septic destruction of the ankle joint with a minimal follow-up of 2 years were retrospectively analyzed. Reinfection rate, fusion rate, functional outcomes, and complications were evaluated.
A total of 25 patients were included with a mean follow-up of 42 months (24-92 months). The mean age was 55 ± 18 years old. At the last follow-up, reinfection occurred in 6 patients (24%) and fusion was obtained in 19 patients (83%). Eight patients (32%) required revision surgery. The mean postoperative modified American Orthopaedic Foot & Ankle Society (AOFAS) score, 12-Item Short Form Health Survey physical and mental component summary scores were respectively 53 ± 19.5, 35.5 ± 11.4, and 46.7 ± 13.5 points.
One-stage TTCA with retrograde IM nail appears to be an acceptable alternative in severe septic destruction of the ankle joint, with a high eradication rate of infection and ankle fusion.
踝关节严重感染性破坏带来了治疗挑战，但缺乏一致的最佳治疗方案。胫距跟关节融合术（TTCA）被认为是一种有价值的挽救性手术，但相关文献仍然稀少。包括两阶段手术在内的传统治疗方法与恢复时间延长和成功率各异有关。许多作者在这些情况下更倾向于经典的外固定，理由是担心内固定物可能会带来反复感染的风险。迄今为止，尚无研究调查使用逆行髓内钉进行一期手术的结果。主要目的是评估在踝关节严重感染性破坏中使用逆行髓内钉进行一期TTCA术后2年的反复感染率。融合率和功能结果作为次要目的进行评估。
对踝关节严重感染性破坏后接受一期TTCA并使用逆行髓内钉且随访至少2年的患者的临床和放射学数据进行回顾性分析。评估再感染率、融合率、功能结果和并发症。
共纳入25例患者，平均随访42个月（24 - 92个月）。平均年龄为55±18岁。在最后一次随访时，6例患者（24%）发生再感染，19例患者（83%）获得融合。8例患者（32%）需要翻修手术。术后平均改良美国矫形足踝协会（AOFAS）评分、12项简明健康调查身体和精神成分汇总评分分别为53±19.5、35.5±11.4和46.7±13.5分。
在踝关节严重感染性破坏中，一期TTCA联合逆行髓内钉似乎是一种可接受的替代方法，具有较高的感染根除率和踝关节融合率。
