Itokazu M, Matsunaga T, Tanaka S
Department of Orthopaedics, Gifu University, Japan.
Foot Ankle Int. 1994 Apr;15(4):191-6. doi: 10.1177/107110079401500407.
We carried out the ankle arthroplasty by excision of the talar body (subtotal talectomy) on 10 ankles of nine patients with talar body tumor, paralytic talipes equinovarus, talipes varus due to spinal injury, or comminuted fracture of the talar body. Talar body excision was initiated by lateral incision and subsequent osteotomy of the fibula. The fibula was everted, leaving the lateral ligament (calcaneofibular ligament) intact. After the talus was exposed, the talar body was excised, leaving about 1.5 cm of head unresected. Subsequently, the fibula was shortened slightly, and the tibia was pulled down to the level of the calcaneus to form a joint, instead of arthrodesis being performed. After surgery, the joint formed by the tibia and calcaneus was mobile in seven of the 10 feet and immobile (arthrodesis) in the remaining three feet. The average follow-up period was 6 years. Although postoperative x-ray revealed slight osteoarthritic changes of Chopart's joint and the tibiocalcaneal joint, none of the patients showed ankle pain that impaired activities of daily living. Subtotal talectomy allows correction of talipes equinus without Achilles tendon lengthening.
我们对9例患有距骨体肿瘤、麻痹性马蹄内翻足、脊髓损伤所致内翻足或距骨体粉碎性骨折的患者的10个踝关节进行了距骨体切除（次全距骨切除术）的踝关节置换术。距骨体切除从外侧切口开始，随后进行腓骨截骨。将腓骨外翻，保留外侧韧带（跟腓韧带）完整。暴露距骨后，切除距骨体，保留约1.5 cm的距骨头未切除。随后，将腓骨稍微缩短，将胫骨向下拉至跟骨水平以形成关节，而不是进行关节融合术。术后，10只足中有7只足的胫骨和跟骨形成的关节可活动，其余3只足的关节固定（关节融合）。平均随访期为6年。尽管术后X线显示距舟关节和胫跟关节有轻微骨关节炎改变，但所有患者均未出现影响日常生活活动的踝关节疼痛。次全距骨切除术可在不延长跟腱的情况下矫正马蹄足。
