Wang D Y
Department of Orthopedics, China Medical College Hospital, Taichung, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 1998 Dec;61(12):694-9.
Over the past decade, arthroscopy has become a well-accepted technique for treating complex ankle problems. Recently, technical refinement with improvements in instrumentation has allowed more extensive arthroscopic debridement. With these improvements, arthroscopy can be used to perform successful arthrodesis of the ankle.
Five arthroscopic ankle arthrodesis procedures were performed. Three patients had post-traumatic osteoarthritis, one had rheumatoid arthritis and one had gouty arthritis combined with pyogenic arthritis. Following arthroscopic resection of the synovial membrane, cartilage and subchondral bone from the tibial, fibular and talar articular surfaces, an autogenous iliac bone graft was performed using arthroscopic guidance. Two percutaneous screws were used for internal fixation in three cases. Postoperatively, patients wore a short leg walking cast for eight weeks. The average follow-up was 18.8 months (range, 12-24 months).
Clinical ankylosis was achieved in all cases and there was radiologic evidence of bone fusion in four cases. In one case, delayed union occurred, but it was achieved at the 12th postoperative month of follow-up.
Arthroscopic ankle arthrodesis is less invasive than open techniques and less painful after surgery; it also allows for a better cosmetic effect. There is a learning curve associated with arthroscopic ankle fusion, and it is time-consuming. Severe deformity is a contraindication for this method and such cases should only be treated using the open method.
在过去十年中，关节镜检查已成为治疗复杂踝关节问题的一种广泛接受的技术。最近，随着器械的改进，技术得到了完善，使得关节镜下清创术的范围更广。有了这些改进，关节镜检查可用于成功实施踝关节融合术。
实施了5例关节镜下踝关节融合手术。3例患者患有创伤后骨关节炎，1例患有类风湿关节炎，1例患有痛风性关节炎合并化脓性关节炎。在关节镜下切除胫骨、腓骨和距骨关节面的滑膜、软骨和软骨下骨后，在关节镜引导下进行自体髂骨移植。3例使用两枚经皮螺钉进行内固定。术后，患者佩戴短腿行走石膏8周。平均随访时间为18.8个月（范围12 - 24个月）。
所有病例均实现临床强直，4例有骨融合的影像学证据。1例出现延迟愈合，但在术后第12个月的随访中实现愈合。
关节镜下踝关节融合术比开放技术侵入性小，术后疼痛较轻；它还能带来更好的美容效果。关节镜下踝关节融合术存在学习曲线，且耗时较长。严重畸形是该方法的禁忌证，此类病例应仅采用开放方法治疗。
