■胫骨关节固定术(TCA)可以通过内固定(髓内钉或钢板)实现,外固定,或组合。最佳方法的证据是有限的。本系统综述检查了这些不同方法的结果,以指导手术管理。
■使用“胫骨,\"\"脚踝,\"\"融合或关节固定术。“主要结果是工会。次要结果包括术后并发症的发生率,负重状态,翻修手术率,我们纳入了任何随访超过6个月的研究,其中包含我们的主要结局和至少1个次要结局.
■最初的搜索产生了164篇文章,其中9项研究共53例符合标准。大多数文章被排除在外,因为它们是非手术研究,或者不是关于孤立的TCA,而是用于胫骨关节固定术,更复杂的重建(例如,Charcot),病例报告,和/或不包括预定的结果度量。外固定术后TCA愈合率为86.2%,82.4%用于髓内钉固定,钢板固定占83.3%。一名患者接受了外固定和内固定的混合治疗,结果是不团结。术后并发症发生率为69.8%。
■关于孤立胫骨关节固定术的最佳手术方法的证据有限。外固定和内固定方法的愈合率相当。外固定有频繁的并发症和更具挑战性的术后方案。3D打印笼子和距骨置换等新技术可能成为一种有希望的替代方案,但需要进一步研究。
UNASSIGNED: Tibiocalcaneal arthrodesis (TCA) can be achieved by internal fixation (intramedullary nail or plate), external fixation, or a combination. Evidence for the optimal approach is limited. This systematic review examines the outcomes of these different approaches to guide surgical management.
UNASSIGNED: A MEDLINE and Oxford SOLO search was performed using \"tibiocalcaneal,\" \"ankle,\" \"fusion OR arthrodesis.\" The primary outcome was union. Secondary outcomes included rates of postoperative complications, weightbearing status, rates of revision surgery, and PROMs. We included any studies with follow-up greater than 6 months that contained our primary outcome and at least 1 secondary outcome.
UNASSIGNED: The initial search yielded 164 articles, of which 9 studies totaling 53 cases met the criteria. The majority of articles were excluded because they were nonsurgical studies, or were not about
isolated TCA but were for tibiotalocalcaneal arthrodesis, more complex reconstructions (eg, Charcot), case reports, and/or did not include the predetermined outcome measures.TCA union rate was 86.2% following external fixation, 82.4% for intramedullary nail fixation, and 83.3% for plate fixation. One patient underwent a hybrid of external and internal fixation, and the outcome was nonunion. The rate of complications following TCA was 69.8%.
UNASSIGNED: There is limited evidence on the best operative approach for
isolated tibiocalcaneal arthrodesis. Both external and internal fixation methods had comparable union rates. External fixation had frequent complications and a more challenging postoperative protocol. Novel techniques such as 3D-printed cages and talus replacement may become a promising alternative but require further investigation.