Staged distraction osteogenesis followed by arthrodesis using internal fixation as a form of surgical treatment for complex conditions of the ankle
Staged distraction osteogenesis followed by arthrodesis using internal fixation as a form of surgical treatment for complex conditions of the ankle
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DOI：
10.1302/0301-620x.100b6.bjj-2017-1188.r1
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发表时间：
2018-06-01
影响因子：
4.6
通讯作者：
Han, P.
中科院分区：
文献类型：
--
作者：
Lou, T-F;Hamushan, M.;Han, P.
AimsThe的目的是本研究的目的是描述技术的牵引成骨，然后通过关节融合术使用内固定来管理复杂的条件下的踝关节，并提出这种technology.Patients和MethodsBetween 2008年和2014年，牵引成骨，然后通过关节融合术使用内固定进行了12例踝关节由于创伤或感染的复杂条件。有8名男性和4名女性：手术时平均年龄为35岁（23至51岁）。根据Paley描述的标准评价骨愈合和功能恢复。功能进行了评估，使用踝后足美国矫形足和踝关节协会（AOFAS）的规模。ResultsA固体融合的踝关节和根除感染的所有患者。平均随访25.2个月（14 - 37），平均延长6.1 cm（2.5 - 14）。平均外固定指数为42天/cm（33.3 ~ 58）。6例患者的功能被判定为优，6例患者的功能被判定为良。10名患者的骨结果被评为优，2名患者为良。术前平均AOFAS评分为37.3（5 - 77），末次随访时为75.3（61 - 82）。保守治疗的轻微并发症包括疼痛、针道感染、钢丝松动和中足僵硬。手术治疗的主要并发症包括V级针道感染伴炎症和骨质溶解、再生骨合并不良和软组织内陷。治疗主要并发症所需的再手术包括针和线的交换，骨移植和内陷分裂surgery.ConclusionThe技术的牵引成骨关节融合术使用内固定是一种有效的治疗形式的复杂条件的踝关节的管理。它提供了一个高愈合率，一个机会，以消除框架早期，并减少了无感染或伤口裂开。
AimsThe aim of this study was to describe the technique of distraction osteogenesis followed by arthrodesis using internal fixation to manage complex conditions of the ankle, and to present the results of this technique.Patients and MethodsBetween 2008 and 2014, distraction osteogenesis followed by arthrodesis using internal fixation was performed in 12 patients with complex conditions of the ankle due to trauma or infection. There were eight men and four women: their mean age was 35 years (23 to 51) at the time of surgery. Bone healing and functional recovery were evaluated according to the criteria described by Paley. Function was assessed using the ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS).ResultsA solid fusion of the ankle and eradication of infection was achieved in all patients. A mean lengthening of 6.1 cm (2.5 to 14) was achieved at a mean follow-up of 25.2 months (14 to 37). The mean external fixation index (EFI) was 42 days/cm (33.3 to 58). The function was judged to be excellent in six patients and good in six patients. Bone results were graded as excellent in ten patients and good in two patients. The mean AOFAS score was 37.3 (5 to 77) preoperatively and 75.3 (61 to 82) at the final follow-up. Minor complications, which were treated conservatively, included pain, pin-tract infection, loosening of wires, and midfoot stiffness. Major complications, which were treated surgically included grade V pin-tract infection with inflammation and osteolysis, poor consolidation of the regenerate bone, and soft-tissue invagination. The reoperations required to treat the major complications included the exchange of pins and wires, bone grafting and invagination split surgery.ConclusionThe technique of distraction osteogenesis followed by arthrodesis using internal fixation is an effective form of treatment for the management of complex conditions of the ankle. It offers a high rate of union, an opportunity to remove the frame early, and a reduced EFI without infection or wound dehiscence.