Pyevich M T, Saltzman C L, Callaghan J J, Alvine F G
Department of Orthopaedic Surgery, University of Iowa, Iowa City 52246, USA.
J Bone Joint Surg Am. 1998 Oct;80(10):1410-20.
We evaluated the intermediate-term results of a novel total ankle arthroplasty that includes insertion of the components without cement and arthrodesis of the tibiofibular syndesmosis as part of the operative procedure. One hundred consecutive Agility ankle replacements were performed in ninety-five patients between 1984 and 1993. At the time of follow-up, eighty-three patients (eighty-six ankles) were alive and twelve patients (fourteen ankles) had died. Five (6 per cent) of the eighty-six ankles in the living patients had been revised. Including the components that had been revised for loosening, twenty-one (twelve tibial and nine talar) components had migrated. Delayed union of the syndesmosis (twenty-eight ankles) and non-union of the syndesmosis (nine ankles) were associated with the development of lysis around the tibial component. Non-union of the syndesmosis was also associated with migration of the tibial component and circumferential radiolucency around that component. In addition to the patients who died, one patient had a resection of the implant with subsequent arthrodesis. The remaining eighty-two patients (eighty-five ankles) were the basis for the clinical evaluation in the study. The average age at the time of the procedure was sixty-three years (range, twenty-seven to eighty-one years). At the time of the most recent follow-up (range, 2.8 to 12.3 years; average, 4.8 years), forty-seven (55 per cent) of the remaining eighty-five ankles were not painful and twenty-four (28 per cent) were only mildly painful. The range of motion of the fifty-six ankles that were examined at the time of follow-up averaged 36 degrees (range, 10 to 64 degrees), and the results for seventy-nine (93 per cent) of the eighty-five ankles were satisfactory to the patients.
我们评估了一种新型全踝关节置换术的中期结果，该手术包括非骨水泥型组件植入以及胫腓联合关节固定术，后者是手术过程的一部分。1984年至1993年间，对95例患者连续进行了100例Agility踝关节置换术。随访时，83例患者（86个踝关节）存活，12例患者（14个踝关节）死亡。存活患者的86个踝关节中有5个（6%）进行了翻修。包括因松动而翻修的组件在内，有21个（12个胫骨组件和9个距骨组件）发生了移位。胫腓联合延迟愈合（28个踝关节）和胫腓联合不愈合（9个踝关节）与胫骨组件周围骨溶解的发生有关。胫腓联合不愈合还与胫骨组件移位以及该组件周围的环形透亮区有关。除了死亡患者外，1例患者进行了植入物切除并随后进行了关节融合术。其余82例患者（85个踝关节）是本研究临床评估的基础。手术时的平均年龄为63岁（范围为27至81岁）。在最近一次随访时（范围为2.8至12.3年；平均为4.8年），其余85个踝关节中有47个（55%）无疼痛，24个（28%）仅有轻微疼痛。随访时检查的56个踝关节的活动范围平均为36度（范围为10至64度），85个踝关节中有79个（93%）的结果患者满意。
