Newton S E
Clin Orthop Relat Res. 1979 Jul-Aug(142):141-5.
Ankle fusion has been the time-honored treatment for painful debilitating conditions of the ankle due to osteoarthritis and rheumatoid arthritis. It is not a uniformly successful operation and has a high complication rate. If there is pre-existing disease in the knee or midtarsal joints, the pain is frequently made worse by ankle fusion. If there is no pre-existing disease, then painful degenerative changes frequently occur in the midtarsal joints subsequently. An artificial ankle joint has been used successfully since 1973 in patients who otherwise would require ankle fusion. The design of the prosthesis allows unrestricted motion in all planes. It also allows imperfect placement of the device without compromising results. The dome of the talus is not resected during insertion of the prosthesis. Only 1 cm of distal tibia is resected, thus allowing fusion without difficulty should it later become necessary. The superior position of the polyethylene device decreases wear from particulate matter which might settle by gravity. Study of 50 total ankle arthroplasty cases shows that predictably good results can be obtained in ankles with good stability, reasonably normal anatomy, and rheumatoids who are not on long-term steroid therapy.
踝关节融合术一直是治疗因骨关节炎和类风湿性关节炎导致的踝关节疼痛性致残病症的传统疗法。它并非是一种总能成功的手术，且并发症发生率很高。如果膝关节或中跗关节已有病变，踝关节融合术常常会使疼痛加剧。如果没有已有病变，那么中跗关节随后常常会出现疼痛性退变改变。自1973年以来，人工踝关节已成功应用于那些原本需要进行踝关节融合术的患者。假体的设计允许在所有平面进行无限制运动。它还允许装置放置不完美但不影响手术效果。在假体植入过程中，距骨穹顶不被切除。仅切除1厘米的胫骨远端，因此如果之后有必要，可顺利实现融合。聚乙烯装置的高位位置减少了可能因重力沉降的颗粒物造成的磨损。对50例全踝关节置换病例的研究表明，在稳定性良好、解剖结构基本正常且未接受长期类固醇治疗的类风湿患者的踝关节中，可获得可预见的良好效果。
