Arthrose de la cheville et de la sous-talienne

N. Biga (Professeur des Universités, praticien hospitalier) , R. Beccari (Chef de clinique des Universités, assistant des Hôpitaux) , J. Simonet (Praticien hospitalier)
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Abstract

Most of the time, ankle and subtalar joint arthrosis are of traumatic origin. Tibiotalar arthrosis is well tolerated usually, except in some cases of malleolar surgical malunion which result in talar malrotation and extremely pathogenic joint incongruence. The most frequently used surgical technique is arthrodesis. This method has good results provided the peroperative position –radiologically controlled – has been determined very cautiously and provided the technique is adapted to anatomical lesions; in particular, adaptation must take into account the necessity of surgery extension to posterior subtalar joint, the key point of preoperative diagnosis. Prosthetic arthroplastic surgery (3rd generation prostheses) is promising. It necessitates further validation by the retrospective analysis of surgical series in terms of implant survival. Isolated subtalar joint arthrosis may benefit from arthrodesis provided local anatomic damage and related impact on the overall foot architecture have been carefully analysed, aiming a surgical technique adapted to the anatomical situation.

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脚踝和下颌骨关节炎
大多数情况下,踝关节和距下关节病都是创伤性的。胫骨关节病通常耐受性良好,但在某些情况下,踝关节手术畸形会导致距骨旋转不良和致病性极强的关节不协调。最常用的手术技术是关节融合术。该方法具有良好的效果,前提是术前位置(放射学控制)已经非常谨慎地确定,并且该技术适用于解剖损伤;特别是适应必须考虑手术延伸至距下后关节的必要性,这是术前诊断的关键。人工关节整形手术(第三代假体)很有前景。这需要通过对植入物存活率方面的手术系列进行回顾性分析来进一步验证。孤立的距下关节病可能受益于关节融合术,前提是已经仔细分析了局部解剖损伤和对整个足部结构的相关影响,旨在采用适合解剖情况的手术技术。
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