Wapner K L
Division of Foot and Ankle Surgery, Allegheny University, Philadelphia, PA, USA.
J Am Acad Orthop Surg. 1998 May-Jun;6(3):188-96. doi: 10.5435/00124635-199805000-00007.
Surgical fusion of the subtalar, talonavicular, and calcaneocuboid joints historically evolved for the treatment of paralytic deformities of the foot where there was often notable bone deformity. Today most of these procedures are performed in adults for posttraumatic arthritis, rheumatoid arthritis, or end-stage posterior tibial tendon rupture with fixed bone deformity. Triple arthrodesis is a technically demanding procedure that generally involves a prolonged recovery time. When proper alignment is obtained, predictable and significant improvement in symptoms occurs, but the resultant loss of hindfoot motion is not without consequence. Residual discomfort and secondary arthrosis of the ankle and tarsometatarsal joints should be expected. Because of the complications of residual deformity, pseudarthrosis, avascular necrosis of the talus, and ankle and midtarsal arthritis, it has been recommended that it be used only as a salvage operation in older patients who have a painful, fixed deformity or disabling instability refractory to other treatment options. Despite these caveats, most patients who undergo triple arthrodesis for appropriate indications report significant improvement in their symptoms and level of function.
距下关节、距舟关节和跟骰关节的手术融合术在历史上是为治疗足部麻痹性畸形而发展起来的，这类畸形通常伴有明显的骨骼畸形。如今，这些手术大多在成人中进行，用于治疗创伤后关节炎、类风湿性关节炎或伴有固定性骨骼畸形的终末期胫后肌腱断裂。三关节融合术是一项技术要求很高的手术，通常需要较长的恢复时间。当获得正确的对线时，症状会出现可预测的显著改善，但后足运动的丧失并非没有后果。应预料到会出现残留不适以及踝关节和跗跖关节的继发性关节炎。由于存在残留畸形、假关节、距骨缺血性坏死以及踝关节和中跗关节关节炎等并发症，有人建议仅将其作为老年患者的挽救手术，这些患者存在疼痛、固定畸形或对其他治疗选择无效的致残性不稳定。尽管有这些注意事项，但大多数因适当适应症接受三关节融合术的患者报告其症状和功能水平有显著改善。
