Abstract：
Arthroscopic ankle arthrodesis (AAA) is a successful treatment for end-stage ankle arthritis. A significant early complication of AAA is symptomatic nonunion. Published nonunion rates range from 8% to 13%. Longer term, there is concern that it predisposes to subtalar joint (STJ) fusion. To better understand these risks, we undertook a retrospective investigation of primary AAA.
All adult AAA cases conducted at our institution over a 10-year period were reviewed. A total of 284 eligible AAA cases in 271 patients were analyzed. The primary outcome measure was radiographic union. Secondary outcome measures included reoperative rate, postoperative complications and subsequent STJ fusion. Univariate and multivariate logistic regression analysis was performed to identify nonunion risk factors.
The overall nonunion rate was 7.7%. Smoking (odds ratio [OR] 4.76 [1.67, 13.6], P = .004) and previous triple fusion (OR 40.29 [9.46, 171.62], P < .001) were independent risk factors on univariate analysis. Only prior triple fusion persisted as a major risk factor associated with nonunion on multivariate analysis (OR 18.3 [3.4, 99.7], P < .001). Seventy percent of patients with a previous triple fusion went on to develop nonunion compared to 5.5% of those without. Increasing age, obesity, surgical grade, diabetes, postoperative weightbearing plan, steroid use, and inflammatory arthropathy were not significant risk factors. The leading cause of reoperation was hardware removal (18%). There were 5 superficial (1.8%) and 4 deep (1.4%) infections. Eleven (4.2%) required subsequent STJ fusion. The \"survivorship\" of STJ post AAA was 98%, 85%, and 74% at 2, 5, and 9 years, respectively.
As the largest study of AAA in the literature, our findings suggest prior triple fusion is a major independent risk factor for AAA nonunion. These patients should be counseled of this high risk and may benefit from alternative surgical options.
Level III, retrospective cohort study.
All adult AAA cases conducted at our institution over a 10-year period were reviewed. A total of 284 eligible AAA cases in 271 patients were analyzed. The primary outcome measure was radiographic union. Secondary outcome measures included reoperative rate, postoperative complications and subsequent STJ fusion. Univariate and multivariate logistic regression analysis was performed to identify nonunion risk factors.
The overall nonunion rate was 7.7%. Smoking (odds ratio [OR] 4.76 [1.67, 13.6], P = .004) and previous triple fusion (OR 40.29 [9.46, 171.62], P < .001) were independent risk factors on univariate analysis. Only prior triple fusion persisted as a major risk factor associated with nonunion on multivariate analysis (OR 18.3 [3.4, 99.7], P < .001). Seventy percent of patients with a previous triple fusion went on to develop nonunion compared to 5.5% of those without. Increasing age, obesity, surgical grade, diabetes, postoperative weightbearing plan, steroid use, and inflammatory arthropathy were not significant risk factors. The leading cause of reoperation was hardware removal (18%). There were 5 superficial (1.8%) and 4 deep (1.4%) infections. Eleven (4.2%) required subsequent STJ fusion. The \"survivorship\" of STJ post AAA was 98%, 85%, and 74% at 2, 5, and 9 years, respectively.
As the largest study of AAA in the literature, our findings suggest prior triple fusion is a major independent risk factor for AAA nonunion. These patients should be counseled of this high risk and may benefit from alternative surgical options.
Level III, retrospective cohort study.
摘要：
■关节镜下踝关节固定术（AAA）是终末期踝关节关节炎的成功治疗方法。AAA的重要早期并发症是有症状的骨不连。公布的不愈合率从8%到13%不等。长期而言,有人担心它容易发生距下关节（STJ）融合。为了更好地理解这些风险，我们对原发性AAA进行了回顾性调查。
■对我们机构在10年内进行的所有成人AAA病例进行了审查。对271例患者中284例合格的AAA病例进行了分析。主要结果指标是影像学结合。次要结果指标包括再次手术率，术后并发症和随后的STJ融合。进行单因素和多因素logistic回归分析以确定不愈合的危险因素。
■总体骨不连率为7.7%。吸烟（赔率比[OR]4.76[1.67，13.6]，P=.004）和先前的三重融合（OR40.29[9.46，171.62]，P<.001)是单因素分析的独立危险因素。在多变量分析中，只有先前的三重融合仍然是与不愈合相关的主要危险因素（OR18.3[3.4，99.7]，P<.001)。先前进行过三重融合的患者中有70％继续发生骨不连，而没有这种情况的患者则为5.5％。年龄增长,肥胖，外科级,糖尿病,术后负重计划,使用类固醇,和炎性关节病不是显著的危险因素。重新操作的主要原因是硬件删除（18％）。有5例浅表（1.8％）和4例深部（1.4％）感染。11人(4.2%)需要随后的STJ融合。AAA后STJ的“存活率”为98%，85%,在2年、5年和9年时占74%，分别。
■作为文献中最大的AAA研究，我们的研究结果表明,既往三联融合是AAA骨不连的主要独立危险因素.这些患者应该被告知这种高风险，并可能受益于其他手术选择。
■三级,回顾性队列研究。
■对我们机构在10年内进行的所有成人AAA病例进行了审查。对271例患者中284例合格的AAA病例进行了分析。主要结果指标是影像学结合。次要结果指标包括再次手术率，术后并发症和随后的STJ融合。进行单因素和多因素logistic回归分析以确定不愈合的危险因素。
■总体骨不连率为7.7%。吸烟（赔率比[OR]4.76[1.67，13.6]，P=.004）和先前的三重融合（OR40.29[9.46，171.62]，P<.001)是单因素分析的独立危险因素。在多变量分析中，只有先前的三重融合仍然是与不愈合相关的主要危险因素（OR18.3[3.4，99.7]，P<.001)。先前进行过三重融合的患者中有70％继续发生骨不连，而没有这种情况的患者则为5.5％。年龄增长,肥胖，外科级,糖尿病,术后负重计划,使用类固醇,和炎性关节病不是显著的危险因素。重新操作的主要原因是硬件删除（18％）。有5例浅表（1.8％）和4例深部（1.4％）感染。11人(4.2%)需要随后的STJ融合。AAA后STJ的“存活率”为98%，85%,在2年、5年和9年时占74%，分别。
■作为文献中最大的AAA研究，我们的研究结果表明,既往三联融合是AAA骨不连的主要独立危险因素.这些患者应该被告知这种高风险，并可能受益于其他手术选择。
■三级,回顾性队列研究。
