Balaban Kamil, Akmeşe Ramazan, Kınık Hüseyin Hakan, Kalem Mahmut
Ankara Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 06230 Altındağ, Ankara, Türkiye.
Jt Dis Relat Surg. 2025 Jun 27;36(3):711-723. doi: 10.52312/jdrs.2025.2380.
This study aims to compare the clinical and radiographic outcomes of open (lateral transfibular) and arthroscopic joint debridement techniques in tibiotalocalcaneal arthrodesis (TTCA) using the same nail system.
Between January 2011 and December 2022, a total of 62 patients (21 males, 41 females; mean age 53.81±16.68 years; range 18 to 82 years) who underwent TTCA with retrograde intramedullary nail were retrospectively analyzed. The patients were classified as open (n=30) or arthroscopy (n=32) based on the method used for joint debridement. Data including demographic characteristics, pre-and postoperative radiographs, skin-to-skin operative times, and fluoroscopy times were recorded. Tibiotalar and subtalar union rates, coronal and sagittal ankle alignment examined through coronal tibiotalar (CTT) and sagittal tibiotalar (STT) angles were also noted. Functional outcomes were measured using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS) and Visual Analog Scale (VAS). Complications were evaluated.
A total of 34 ankles (n=30) underwent open TTCA, while 34 ankles (n=32) had arthroscopic TTCA. Baseline characteristics and follow-up duration were similar between the groups (p>0.05). The overall fusion rate (tibiotalar and subtalar) was 94.1% in the open group and 85.3% in the arthroscopic group (p=0.425). Both open and arthroscopy groups achieved satisfactory coronal and sagittal ankle alignment. The median CTT angles were 94° and 91°, and STT angles were 109° and 112°, respectively. The arthroscopy group had significantly shorter operative time, fluoroscopy time, and hospital stay (p<0.001, p=0.019, p<0.001, respectively). No significant differences were found in complication rates, postoperative AOFAS-AHS, and VAS scores (p>0.05).
Both open and arthroscopic TTCA approaches yielded similar radiographic and clinical outcomes. Based on these findings, we can speculate that the arthroscopic technique may offer advantages in perioperative efficiency, suggesting it is a viable alternative in appropriately selected patients.
本研究旨在比较使用相同髓内钉系统的开放（经腓骨外侧）和关节镜下关节清理技术在胫距跟关节融合术（TTCA）中的临床和影像学结果。
回顾性分析2011年1月至2022年12月期间，62例行逆行髓内钉固定的TTCA患者（男21例，女41例；平均年龄53.81±16.68岁；年龄范围18至82岁）。根据关节清理方法将患者分为开放组（n = 30）和关节镜组（n = 32）。记录包括人口统计学特征、术前和术后X线片、皮肤到皮肤的手术时间以及透视时间等数据。还记录了通过胫距关节冠状面（CTT）和胫距关节矢状面（STT）角度检查的胫距关节和距下关节融合率、冠状面和矢状面踝关节对线情况。使用美国矫形足踝协会踝 - 后足评分（AOFAS - AHS）和视觉模拟量表（VAS）测量功能结果。评估并发症情况。
共34例踝关节（n = 30）接受了开放TTCA，34例踝关节（n = 32）接受了关节镜下TTCA。两组间基线特征和随访时间相似（p>0.05）。开放组的总体融合率（胫距关节和距下关节）为94.1%，关节镜组为85.3%（p = 0.425）。开放组和关节镜组在冠状面和矢状面踝关节对线方面均达到满意效果。CTT角中位数分别为94°和91°，STT角分别为109°和112°。关节镜组的手术时间、透视时间和住院时间明显更短（分别为p<0.001、p = 0.019、p<0.001）。并发症发生率、术后AOFAS - AHS评分和VAS评分差异无统计学意义（p>0.05）。
开放和关节镜下TTCA方法产生相似的影像学和临床结果。基于这些发现，我们可以推测关节镜技术在围手术期效率方面可能具有优势，表明在适当选择的患者中它是一种可行的替代方法。
