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Abstract：
OBJECTIVE: To analyze the clinical data of patients with end-stage ankle and hindfoot arthropathy who underwent tibiotalocalcaneal (TTC) arthrodesis by the same surgeon, explore the short- and mid-term clinical results, complications and functional improvement, and discuss the clinical prognosis and precautions of TTC arthrodesis.
METHODS: Retrospective analysis was made on the clinical data of 40 patients who underwent TTC arthrodesis by the same surgeon from March 2011 to December 2020. In this study, 23 males and 17 females were included, with an average age of (49.1±16.0) years. All the patients underwent unilateral surgery. The clinical characteristics, imaging manifestations, main diagnosis and specific surgical techniques of the patients were recorded. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) between pre-operation and at the last follow-up. The fusion healing time, symptom improvement (significant improvement, certain improvement, no improvement or deterioration) and postoperative complications were also recorded.
RESULTS: The median follow-up time was 38.0 (26.3, 58.8) months. The preoperative VAS score was 6.0 (4.0, 7.0), and the AOFAS score was 33.0 (25.3, 47.3). At the last follow-up, the median VAS score was 0 (0, 3.0), and the AOFAS score was 80.0 (59.0, 84.0). All the significantly improved compared with their preoperative corresponding values (P < 0.05). There was no wound necrosis or infection in the patients. One patient suffered from subtalar joint nonunion, which was syphilitic Charcot arthropathy. The median bony healing time of other patients was 15.0 (12.0, 20.0) weeks. Among the included patients, there were 25 cases with significant improvement in symptom compared with that preoperative, 8 cases with certain improvement, 4 cases with no improvement, and 3 cases with worse symptoms than that before operation.
CONCLUSIONS: TTC arthrodesis is a reliable method for the treatment of the end-stage ankle and hindfoot arthropathy. The function of most patients was improved postoperatively, with little impact on daily life. The causes of poor prognosis included toe stiffness, stress concentration in adjacent knee joints, nonunion and pain of unknown causes.
METHODS: Retrospective analysis was made on the clinical data of 40 patients who underwent TTC arthrodesis by the same surgeon from March 2011 to December 2020. In this study, 23 males and 17 females were included, with an average age of (49.1±16.0) years. All the patients underwent unilateral surgery. The clinical characteristics, imaging manifestations, main diagnosis and specific surgical techniques of the patients were recorded. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) between pre-operation and at the last follow-up. The fusion healing time, symptom improvement (significant improvement, certain improvement, no improvement or deterioration) and postoperative complications were also recorded.
RESULTS: The median follow-up time was 38.0 (26.3, 58.8) months. The preoperative VAS score was 6.0 (4.0, 7.0), and the AOFAS score was 33.0 (25.3, 47.3). At the last follow-up, the median VAS score was 0 (0, 3.0), and the AOFAS score was 80.0 (59.0, 84.0). All the significantly improved compared with their preoperative corresponding values (P < 0.05). There was no wound necrosis or infection in the patients. One patient suffered from subtalar joint nonunion, which was syphilitic Charcot arthropathy. The median bony healing time of other patients was 15.0 (12.0, 20.0) weeks. Among the included patients, there were 25 cases with significant improvement in symptom compared with that preoperative, 8 cases with certain improvement, 4 cases with no improvement, and 3 cases with worse symptoms than that before operation.
CONCLUSIONS: TTC arthrodesis is a reliable method for the treatment of the end-stage ankle and hindfoot arthropathy. The function of most patients was improved postoperatively, with little impact on daily life. The causes of poor prognosis included toe stiffness, stress concentration in adjacent knee joints, nonunion and pain of unknown causes.
摘要：
目的：分析由同一外科医生进行胫骨关节固定术（TTC）的终末期踝关节和后足关节病患者的临床资料。探索短期和中期临床结果，并发症和功能改善，并讨论TTC关节固定术的临床预后及注意事项。
方法：回顾性分析2011年3月至2020年12月由同一外科医生进行TTC关节固定术的40例患者的临床资料。在这项研究中,包括23名男性和17名女性，平均年龄(49.1±16.0)岁。所有患者均行单侧手术。临床特点,影像学表现,记录患者的主要诊断和具体手术技术。通过比较术前和末次随访之间的美国骨科足踝协会（AOFAS）踝足-后足评分和视觉模拟评分（VAS）来评估临床结果。融合愈合时间，症状改善(显著改善，一定的改进,没有改善或恶化）和术后并发症也被记录。
结果：中位随访时间为38.0(26.3,58.8)个月。术前VAS评分为6.0(4.0,7.0),AOFAS评分为33.0(25.3,47.3)。在最后一次随访中，中位VAS评分为0（0，3.0），AOFAS评分为80.0(59.0,84.0)。所有指标较术前相应值显著改善(P<0.05)。患者无伤口坏死或感染。一名患者患有距下关节骨不连，那就是梅毒性Charcot关节病.其他患者的中位骨性愈合时间为15.0（12.0，20.0）周。在纳入的患者中，有25例与术前相比症状明显改善，有一定改善的8例,4例没有改善，症状较术前加重3例。
结论：TTC关节固定术是治疗终末期踝关节和后足关节病的可靠方法。大多数患者术后功能得到改善，对日常生活影响不大。预后不良的原因包括脚趾僵硬，相邻膝关节的应力集中，不明原因的不愈合和疼痛。
方法：回顾性分析2011年3月至2020年12月由同一外科医生进行TTC关节固定术的40例患者的临床资料。在这项研究中,包括23名男性和17名女性，平均年龄(49.1±16.0)岁。所有患者均行单侧手术。临床特点,影像学表现,记录患者的主要诊断和具体手术技术。通过比较术前和末次随访之间的美国骨科足踝协会（AOFAS）踝足-后足评分和视觉模拟评分（VAS）来评估临床结果。融合愈合时间，症状改善(显著改善，一定的改进,没有改善或恶化）和术后并发症也被记录。
结果：中位随访时间为38.0(26.3,58.8)个月。术前VAS评分为6.0(4.0,7.0),AOFAS评分为33.0(25.3,47.3)。在最后一次随访中，中位VAS评分为0（0，3.0），AOFAS评分为80.0(59.0,84.0)。所有指标较术前相应值显著改善(P<0.05)。患者无伤口坏死或感染。一名患者患有距下关节骨不连，那就是梅毒性Charcot关节病.其他患者的中位骨性愈合时间为15.0（12.0，20.0）周。在纳入的患者中，有25例与术前相比症状明显改善，有一定改善的8例,4例没有改善，症状较术前加重3例。
结论：TTC关节固定术是治疗终末期踝关节和后足关节病的可靠方法。大多数患者术后功能得到改善，对日常生活影响不大。预后不良的原因包括脚趾僵硬，相邻膝关节的应力集中，不明原因的不愈合和疼痛。
