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行動学

外侧 Transfibular 法治疗踝关节骨性关节炎

Published: January 24, 2018
doi:
10.3791/56396
, , , ,
1Galeazzi Orthopedic Institute for Research and Care, 2Dipartimento di Scienze Biomediche per la Salute,Università degli Studi di Milano

概要

我们提出了我们的术前, 手术和术后的方案, 治疗踝关节骨性关节炎的全踝关节置换通过侧 transfibular 方法。

Abstract

全踝关节置换术 (TAR) 是治疗踝关节骨关节炎的有效方法。传统的焦油手术方法是前路。最近, 侧 transfibular 方法的脚踝已经得到了普及, 因为一个新的焦油种植体的设计是通过这种方法, 结果在一个理想的可视化的中心旋转的脚踝和弯曲的切除, 允许减少骨切。本论文的目的是提出我们的术前, 手术, 和术后的治疗踝关节骨关节炎的侧方方法。我们提出了我们的术前临床和放射学协议。此外, 我们用一些技术技巧来描述我们的外科技术。最后, 我们报告我们的随访时间表, 包括临床、功能和放射学数据的收集。这个过程的结果是令人鼓舞的: 通过横向 transfibular 的焦油提供了可靠的疼痛缓解和改善的功能性结局的踝关节骨关节炎。

Introduction

踝关节骨关节炎最常见的病因是创伤后的起源。事实上, 它通常继发于外伤性损伤, 通常影响年轻患者1,2。踝关节骨关节炎影响患者的生活质量与髋关节骨关节炎, 甚至超过膝骨关节炎的程度,3。踝关节融合已被认为是治疗踝关节骨关节炎的金本位, 但一些研究表明, 它赋予了增强应力, 增加了邻近关节骨关节炎的风险4,5,6 ,7;此外, 还存在一些与踝关节融合相关的并发症, 如 equinus 或马蹄畸形和痛苦的非联合8,9。随着外科技术和种植体设计的发展, 全踝关节置换术 (TAR) 已成为一个优秀的替代踝关节融合的外科医生与正确的学习曲线10,11,12。

焦油允许保留踝关节的运动范围和保护从相邻的关节变性13。前面的方法允许一个最佳的可视化的日冕对齐;同时, 此方法倾向于伤口愈合并发症14,15。最近, 一个新的焦油种植体的设计是通过横向 transfibular 的方法, 导致一个理想的可视化中心的旋转和弯曲的切除, 允许不遗余力的骨削减16;此外, 这种方法允许植入垂直于骨小的组成部分, 从而限制了在骨种植界面的水平的剪切力16。这个假肢由一个固定的轴承植入物组成;对齐坐标系引导骨切除, 并有助于解决冠状和矢状畸形的17。使用该焦油植入物的踝关节置换术的早期结果已被发布12,16,17,18。本论文的目的是提出我们的术前, 手术, 和术后的治疗踝关节骨关节炎的侧方方法。

病人的选择从仔细的临床检查和历史开始。病史的炎症或血管疾病, 神经病变或神经系统疾病和复杂的糖尿病可能改变的迹象。不良的脚踝软组织包络应仔细评估, 因为它可能会损害伤口愈合: 皮肤和皮下软组织可能已经被损害或以前的手术。必须考虑使用可能影响愈合的药物。肌肉和肌腱功能, 踝关节和足对齐, 和踝关节运动范围应评估: 详细的检查可以表明是否需要辅助程序在手术时的19。

我们建议经常讨论病人对手术结果的期望和对术后护理依从性的要求。焦油是指踝关节疾病的患者, 由于创伤后, 类风湿, 或原发性关节炎不响应保守的选择, 包括物理治疗, 活性修饰, 非甾体抗炎药物19.此外, 侧踝不稳可能是关节退行性病变的原因, 定义为韧带外伤后踝关节骨关节炎20。此外, 继发性骨关节炎可与系统性疾病有关: 骨距、痛风、血友病、感染后关节炎和遗传性沉着的缺血性坏死21、22、23, 24。

在术前会诊期间, 我们例行记录以下临床和功能评分: 美国骨科足 & 踝关节 (AOFAS) 踝关节和足评分25,26,27, 12 项短表单健康调查27、28和可视模拟比例 (VAS) 疼痛评分29。

Protocol

所描述的所有方法都已得到我们的机构审查委员会和地方道德操守小组的批准, 它们是按照1964《赫尔辛基宣言》及其后的修正案所规定的道德标准进行的。 1. 术前影像学评价 用前后、侧向和 rearfoot 对齐视图 (萨尔茨曼的视图30) 执行踝关节和足部的负重照相。 执行一个常规的计算机断层扫描 (CT) 的脚踝, 并要求任何其他诊断检查 (如磁共振), ?…

Representative Results

我们收集的结果, 连续114例 (114 踝) 谁接受了焦油通过横向 transfibular 方法之间的2013年5月至2016年7月。所有执行程序均由高级提交人执行。 使用统计软件分析数据 (请参见材料表)。方差分析和卡帕测试执行40,41。对于 k 分数, 定义了95% 置信区间。在p< 0.05 中, 我们认…

Discussion

我们报告的方法和协议, 我们使用执行焦油横向 transfibular 方法。焦油的绝对禁忌症是距缺血性坏死, 涉及50% 以上的骨储备, 急性或积极感染或无骨髓炎, 糖尿病综合征神经病, 高 anesthesiologic 风险, 神经肌肉障碍, 周围血管疾病, neuroarthropathy (腓骨关节足或足)19,42。相对禁忌症是糖尿病综合征没有神经病, 免疫抑制剂治疗和严重骨质疏松症19</su…

開示

The authors have nothing to disclose.

Acknowledgements

该程序的执行使用的是捷小梁金属全踝假体 (在华沙, 在)。

Materials

Zimmer Total Ankle Zimmer, Inc. 82-0175-162-00 Total Ankle Replacement
Calcaneus pin Zimmer, Inc. 00-4501-040-00 Trans-calcaneal pin
4.0 mm Pin Zimmer, Inc. 00-4501-040-04 Talar pin
5.0 mm Pin Zimmer, Inc. 00-4501-040-05 Tibial pins
1.6 mm k-wire Zimmer, Inc. 00-4501-040-01 1.6 mm Kirschner wire
Moonray BlueLIne Dual SIMAD Mobile C-arm
Pre-Cut Guide Drill Zimmer, Inc. 00-4501-059-00 Precutting bone drill
Bur Zimmer, Inc. 00-4501-076-00 Bone resection burr
Micro 100 Drill Conmed Corporation 5053-009 Pneumatic handpieces
3.5 mm ULS screws Zimmer, Inc. Fibular fixation screws
Matlab version 2008 The MathWorks Inc. Statistical software
DOWNLOAD MATERIALS LIST

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タグ

Ankle OsteoarthritisTotal Ankle ReplacementLateral Transfibular ApproachAnkle Joint AlignmentAnkle Motion PreservationJoint ReconstructionFibular OsteotomyAnkle BiomechanicsTalar WidthTranstalar Pin

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記事を引用
Usuelli, F. G., D’Ambrosi, R., Manzi, L., Maccario, C., Indino, C. Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach. J. Vis. Exp. (131), e56396, doi:10.3791/56396 (2018).
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