Badell Jay S, Cottom James M, Ekladios Josh
Hancock Orthopedics, Hancock Health, 801 N. State St., Greenfield, IN 46140.
Florida Orthopedic Foot & Ankle Center Fellowship, 5741 Bee Ridge Rd #490, Sarasota, FL 34233.
J Foot Ankle Surg. 2025 Jul-Aug;64(4):334-337. doi: 10.1053/j.jfas.2024.12.006. Epub 2025 Jan 10.
Joint arthrodesis is a very common surgical approach in foot and ankle surgery at various anatomic levels. Several techniques have demonstrated the ability to provide successful fusion with appropriate preparation of the joint in question. With that in mind, the joint preparation, regardless of approach or instrumentation, is consistently the most time-consuming. Additionally, this step is prone to eventual complications like shortening with saw cuts or inadequate preparation with curettes and osteotomes alone, not to mention the persistent threat of non-union as is the case with any osteotomy or arthrodesis. Power rasp instrumentation presents a potential alternative for the surgeon to not only improve operating room efficiency, but also provide fast, reproducible, and adequate joint preparation thereby yielding excellent union rates. This study retrospectively analyzed 418 total arthrodesis attempts performed on 198 patients. Procedures included Lapidus bunionectomy/1st tarsometatarsal joint (TMTJ) fusion, midfoot fusions involving more than one TMTJ, isolated subtalar joint fusions (STJ), isolated talonavicular fusions (TNJ), and triple arthrodesis (STJ, TNJ, CCJ). The procedures were performed at a single institution with power rasp joint preparation (PJRP) as the primary tool for debridement of all cartilage from the articular surfaces of the joint in question. Minimum follow-up was 12 months. Radiographic union was defined on X-rays with osseous bridging and trabeculation across the fusion site using standard weightbearing foot radiographs taken at 3-, 6-, and 12-month intervals postoperatively. Four- and one-half percent of all arthrodesis attempts went on to develop a radiographic non-union after 12 months (19/418). This study demonstrates excellent overall union rates using a simple device that provides ease of surgeon use, minimal risk of non-union, and time-cost efficiency for providers, patients, and facilities alike.
关节融合术是足踝外科在不同解剖层面上非常常见的手术方法。多种技术已证明，在对相关关节进行适当准备的情况下，能够实现成功融合。考虑到这一点，无论采用何种方法或器械，关节准备始终是最耗时的。此外，这一步骤容易出现诸如锯切导致缩短或仅用刮匙和骨凿准备不充分等最终并发症，更不用说与任何截骨术或关节融合术一样存在骨不连的持续风险。动力锉器械为外科医生提供了一种潜在的替代方法，不仅可以提高手术室效率，还能提供快速、可重复且充分的关节准备，从而获得出色的融合率。本研究回顾性分析了对198例患者进行的418次全关节融合术尝试。手术包括拉皮德斯拇囊炎切除术/第一跖跗关节（TMTJ）融合术、涉及多个TMTJ的中足融合术、孤立的距下关节融合术（STJ）、孤立的距舟关节融合术（TNJ）和三关节融合术（STJ、TNJ、CCJ）。这些手术在单一机构进行，使用动力锉关节准备（PJRP）作为从相关关节的关节表面清除所有软骨的主要清创工具。最短随访时间为12个月。根据术后3个月、6个月和12个月拍摄的标准负重足部X光片，在X光片上通过融合部位的骨桥和骨小梁来定义影像学融合。在12个月后，所有关节融合术尝试中有4.5%出现了影像学骨不连（19/418）。本研究表明，使用一种简单的器械可获得出色的总体融合率，该器械使用方便，骨不连风险极小，对医护人员、患者和医疗机构而言均具有时间成本效益。
