使用髓内钉的胫骨关节固定术(TTCA)已用于踝关节和距下关节的严重畸形。虽然已经报道了TTCA的良好临床结果,它的不愈合率相对较高。我们报告了一例65岁的男性,使用逆行髓内钉进行TTCA后,胫骨关节骨不连和距下关节破坏。对这个病人来说,我们对距下关节进行了抢救手术,同时对胫骨关节进行了翻修手术,以实现骨愈合。取出髓内钉,并清创胫骨关节。从距骨的外侧收获两个骨软骨栓并移植到距下关节。使用螺钉和U形钉固定胫骨关节,植骨。手术后六个月的磁共振成像(MRI)显示距下关节的关节表面被冲洗,骨软骨塞与周围的骨结合。手术后一年零三个月,胫骨和距下关节的疼痛已完全消失。X线平片显示,胫骨关节和距下关节的关节间隙的骨结合得以维持。在最后的随访中,日本足外科学会(JSSF)后足量表从53分提高到84分。使用骨软骨自体移植重建距下关节是TTCA后胫骨和距下关节不愈合失败的有用技术。
Tibiotalocalcaneal arthrodesis (TTCA) using the intramedullary nail has been conducted for severe deformity of both ankle and subtalar joints. While good clinical outcomes have been reported for TTCA, its nonunion rate is relatively high. We report a
case of a 65-year-old male with nonunion of the tibiotalar joint and destruction of the subtalar joint after TTCA using a retrograde intramedullary nail. For this patient, we conducted a salvage procedure for the subtalar joint along with revision surgery for the tibiotalar joint to achieve bone union. The intramedullary nail was removed and the tibiotalar joint was debrided. Two osteochondral plugs were harvested from the lateral aspect of the talus and transplanted to the subtalar joint. The tibiotalar joint was fixed using screws and staples, with bone grafting. Magnetic resonance imaging (MRI) at six months after surgery showed that the articular surface of the subtalar joint was flushed and the osteochondral plugs were united with the surrounding bone. At one year and three months after surgery, the pain in the tibiotalar and subtalar joints had completely disappeared. Plain radiographs revealed that bone union of the tibiotalar joint and joint space of the subtalar joint was maintained. Japanese Society for Surgery of the Foot (JSSF) hindfoot scale improved from 53 points to 84 points at the final follow-up. Reconstruction of the subtalar joint using osteochondral autologous transplantation is a useful technique for failure cases with nonunion of the tibiotalar and subtalar joints after TTCA.