背景:距骨的假体置换对足踝外科医生提出了重大挑战。距骨上的剪切力和压缩力及其微弱的血液供应导致高的无血管坏死率和最终的距骨塌陷。这项系统评价的目的是评估在有无血管坏死或严重创伤病史的患者中,使用适当的安全性指标来评估全踝距骨置换(TATTR)是否可以改善临床和影像学结果。
方法:我们搜索了距骨的概念,假肢,和MEDLINE(PubMed)的关节成形术,Embase(Elsevier),CINAHL完成(EBSCOhost),和Scopus(Elsevier)从数据库的成立到2023年3月9日。纳入标准是1)距骨先前的创伤,2)胫骨关节创伤后关节炎,3)距骨缺血性坏死,4)多次失败的先前干预,5)退行性骨关节炎对胫骨关节,和6)胫骨关节的炎性关节病。年龄小于18岁的患者和非英语的手稿被排除在外。
结果:在7625篇参考文献中,16项研究符合纳入标准,从136名患者(139个脚踝)获得数据。这些研究的设计各不相同,以病例报告和回顾性病例系列为主。总体加权平均改良的Coleman方法论评分(mCMS)为100分之70.4,表明研究设计中的中度缺陷可能受到各种形式的偏见和可能的混杂因素的影响。人口统计学显示了各种各样的病因,以氧化铝陶瓷为主要假体材料。功能评分显示背屈和跖屈改善,尽管患者报告的结局指标(PRO)报告不一致。并发症包括骨折,异位骨化,延长伤口愈合,和感染。修订细节报告很少。
结论:TATTR是改善缺血性坏死或创伤相关问题患者的短期功能结局的一种有希望的治疗方式。然而,这一系统审查强调了标准化报告的必要性,长期随访,并进一步研究以确定该程序的有效性和安全性,特别是与其他治疗方式相比。
方法:III,四级研究的系统评价。
BACKGROUND: Prosthetic substitution of the
talus presents a significant challenge to the foot and ankle surgeon. The shear and compressive forces on the
talus and its tenuous blood supply lead to high rates of avascular necrosis and eventual talar collapse. The purpose of this systematic
review is to evaluate whether total ankle total
talus replacement (TATTR) leads to improved clinical and radiographic outcomes with appropriate safety metrics in patients with a history of avascular necrosis or significant trauma.
METHODS: We searched the concepts of talus, prosthesis, and arthroplasty in MEDLINE (PubMed), Embase (Elsevier), CINAHL Complete (EBSCOhost), and Scopus (Elsevier) from the database\'s inception through March 9, 2023. Inclusion Criteria were 1) previous trauma to the talus, 2) post-traumatic arthritis to the tibiotalar joint, 3) avascular necrosis of talus, 4) multiple failed prior interventions, 5) degenerative osteoarthritis to the tibiotalar joint, and 6) inflammatory arthropathy to tibiotalar joint. Patients less than 18 years of age and manuscripts in non-English languages were excluded.
RESULTS: Of the 7625 references, 16 studies met the inclusion criteria, yielding data from 136 patients (139 ankles). The studies varied in design, with case reports and retrospective case series being predominant. The overall weighted average modified Coleman Methodology Score (mCMS) was 70.4 out of 100, indicating moderate flaws in study design that may be subject to various forms of bias and possible confounders. Demographics showed a diverse range of etiologies, with alumina ceramic being the primary prosthesis material. Functional scores demonstrated improvements in dorsiflexion and plantarflexion, although patient-reported outcome measures (PROs) were inconsistently reported. Complications included fractures, heterotopic ossification, prolonged wound healing, and infections. Revision details were sparsely reported.
CONCLUSIONS: TATTR is a promising treatment modality for improving short-term functional outcomes for patients with avascular necrosis or trauma-related issues. However, this systematic
review underscores the need for standardized reporting, longer-term follow-ups, and further research to establish the procedure\'s efficacy and safety, particularly in comparison to other treatment modalities.
METHODS: III, Systematic
Review of Level IV Studies.