Foot and Ankle Surgery最新文献_第9页

Early experience with a 3-D printed porous surface, fixed-bearing, total ankle arthroplasty: A minimum of 2-year follow-up 3-D 打印多孔表面固定轴承全踝关节成形术的早期经验：至少两年的随访

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-07-01 DOI: 10.1016/j.fas.2024.02.008

Joseph Duff, Jordan Dunson, Jesse F. Doty

Background

This is a pilot study reviewing patients undergoing ankle replacement with the 3-D printed INFINITY™ with ADAPTIS™ total ankle arthroplasty (TAA) system.

Methods

A retrospective review was conducted of patients with a minimum two-year follow-up who underwent TAA with the INFINITY™ with ADAPTIS™ implant system. Outcome measures include implant survivorship, complications with subsequent reoperations, patient reported outcomes, and radiologic subsidence or radiolucency.

Results

Thirty patients were included with median follow-up of 26 months (range, 24–36). Implant survival rate was 90% (27/30). Two patients experienced linear radiolucency > 2 mm: one required a revision TAA secondary to tibial subsidence; the other patient was asymptomatic and nonprogressive on serial radiographs. No cystic radiolucencies > 5 mm were identified. VAS, PROMIS PF, and FADI scores improved significantly.

Conclusion

TAA performed with the 3-D printed INFINITY™ with ADAPTIS™ implant technology led to ninety percent short term implant survivorship and improvement in patient reported outcomes with comparable results to other 4th generation arthroplasty systems as a treatment modality for end-stage ankle arthritis.

Level of evidence

Level III, Retrospective cohort study, Prognostic

这是一项试验性研究，对使用 3-D 打印 INFINITY™ with ADAPTIS™ 全踝关节置换术（TAA）系统进行踝关节置换的患者进行回顾性研究。该研究对使用 INFINITY™ with ADAPTIS™ 植入系统接受踝关节置换术的患者进行了至少两年的回顾性研究。结果指标包括植入物存活率、随后再次手术的并发症、患者报告的结果以及放射学沉降或放射透明。30 名患者的中位随访时间为 26 个月（24-36 个月）。植入物存活率为 90%（27/30）。有两名患者的线性放射影大于 2 毫米：其中一名患者因胫骨下陷而需要进行 TAA 翻修术；另一名患者无症状，连续拍片检查也无进展。没有发现直径大于 5 毫米的囊性放射性肿物。VAS、PROMIS PF和FADI评分明显改善。使用带有 ADAPTIS™ 植入物技术的 3-D 打印 INFINITY™ 进行 TAA 手术后，植入物的短期存活率达到 90%，患者报告的结果也有所改善，与其他 4 代关节成形系统作为治疗终末期踝关节炎的方法相比，效果相当。III级，回顾性队列研究，预后性

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引用次数: 0

Subtalar arthroereisis with metallic implant is a safe and effective treatment for pediatric patients with symptomatic flexible flatfeet. A 10-year clinical and radiographic follow-up. 对有症状的灵活扁平足儿童患者而言，使用金属植入物进行踝关节置换术是一种安全有效的治疗方法。10年临床和放射学随访。

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-06-27 DOI: 10.1016/j.fas.2024.06.004

Giacomo Moraca, Nicolò Martinelli, Alberto Bianchi, Giuseppe Filardo, Valerio Sansone

Background: Subtalar arthroereisis (SA) is an increasingly applied minimally invasive approach for flexible flat foot (FFF) not responsive to conservative treatment. This study aimed at evaluating the long-term clinical and radiographic outcomes of SA in pediatric patients with symptomatic FFF.

Methods: Thirty-seven patients (11.9 ± 1.6yy) underwent SA (74 feet), with outcomes assessed after a mean 10-year follow-up. Pain, quality of life, foot functionality, and alignment were evaluated using validated tools and radiographic parameters, calculated on weightbearing x-rays pre- and post-operatively.

Results: Clinical outcomes reached excellent postoperative results (FFI: 9.1, AOFAS: 94.5) with a low 0.9 NRS pain (p < 0.01) and a 92 % satisfaction. All radiographic parameters improved significantly towards normal values: CP 17.5 ± 3.9, MA 4.3 ± 5.8, TCA 42.8 ± 6.2, TNCA 21.1 ± 8.5, TNU% 26.6 ± 8.4 (all p < 0.01).

Conclusions: SA with a metallic endosinotarsal device provided significant long-term clinical and radiographic improvements, with low complication rates and high patient satisfaction, supporting its efficacy as a treatment option for pediatric symptomatic FFF.

Level of evidence: IV.

背景：对于保守治疗无效的柔性扁平足（FFF），踝关节置换术（SA）是一种应用日益广泛的微创方法。本研究旨在评估SA对有症状的儿童扁平足患者的长期临床和影像学疗效：37名患者（11.9±1.6yy）接受了SA手术（74只脚），平均随访10年后对结果进行评估。结果：术后临床疗效极佳：临床结果：术后效果极佳（FFI：9.1，AOFAS：94.5），NRS 疼痛低至 0.9（P 结论：术后疼痛轻微：使用金属趾跖内固定器进行SA治疗可显著改善长期临床和影像学效果，并发症发生率低，患者满意度高，支持其作为治疗小儿无症状FFF的有效方法：证据等级：IV。

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引用次数: 0

The variation of anticoagulation prescribed in foot and ankle surgery in the UK - UK foot and ankle thrombo-embolism audit (UK-FATE). 英国足踝手术抗凝处方的变化--英国足踝血栓栓塞审计（UK-FATE）。

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-06-26 DOI: 10.1016/j.fas.2024.06.005

Lyndon Mason, Jitendra Mangwani, Linzy Houchen-Wolloff, Aiden Smith, Lucy Teece, Sarah Booth, Karan Malhotra

Introduction: Venous thrombo-embolism (VTE) is a recognised complication of foot and ankle surgery. There are multiple possible anticoagulation treatments available in the UK to mitigate the risk of developing VTE. Our primary objective was to assess the variability of chemical anticoagulation prescribed in patients undergoing foot and ankle procedures.

Methods: This was a UK-based national, multicenter, prospective audit spanning a collection duration of 9 months on all foot and ankle procedures, carried out in 68 UK centers between 1st June 2022 and 30th November 2022, with a further 3-month follow up period. All patients who underwent a foot and ankle surgical procedure (including Achilles tendon rupture treatment) were included in this study.

Results: Data on a total of 13,569 patients was submitted. Following data cleansing, 11,363 patients were available for further analysis, with anticoagulation data available for 11,099 patients. There were eleven different chemical anticoagulation treatments recorded across the cohort. A total of 3630 (31.95 %) patients received no chemical anticoagulation. The patients receiving chemical anticoagulation medication could be split into 4 main groups. The most common chemical anticoagulation received was low molecular weight heparin (LMWH) (6303, 84.4 % of patients receiving chemical anticoagulation). Aspirin was given in 4.1 % (308 patients), a Factor Xa inhibitor in 10 % (744 patients) and other anticoagulants (e.g. Warfarin) in 1.5 % (114 patients). The overall VTE rate in this sub analysis of patients receiving chemical anticoagulation, was 1.1 % (83 cases out of 7469). There was no significant difference seen in incidence of VTE between types of anticoagulants, when confounding factors were considered. The duration of post-operative chemical prophylaxis used by participants for most chemical anticoagulants was 6 weeks (64.50 %).

Conclusion: There was significant variability of chemical anticoagulants reported in the study, with five different categories of anticoagulants used (including no chemical anticoagulation), and none clearly superior/inferior. The duration of anticoagulation was consistent across types of thromboprophylaxis.

导言：静脉血栓栓塞（VTE）是公认的足踝手术并发症。在英国，有多种可能的抗凝治疗方法可用于降低罹患 VTE 的风险。我们的主要目标是评估为接受足踝手术的患者开具的化学抗凝处方的可变性：这是一项基于英国的全国性多中心前瞻性审计，在 2022 年 6 月 1 日至 2022 年 11 月 30 日期间，在英国 68 个中心对所有足踝手术进行了为期 9 个月的收集，并进行了为期 3 个月的随访。所有接受足踝外科手术（包括跟腱断裂治疗）的患者均被纳入本研究：共提交了 13,569 名患者的数据。经过数据清理后，有 11,363 名患者的数据可供进一步分析，其中有 11,099 名患者的抗凝数据可供分析。整个队列中共记录了 11 种不同的化学抗凝治疗。共有 3630 名患者（31.95%）未接受化学抗凝治疗。接受化学抗凝药物治疗的患者可分为四大类。最常见的化学抗凝药物是低分子量肝素（LMWH）（6303 人，占接受化学抗凝药物治疗患者的 84.4%）。阿司匹林占 4.1%（308 名患者），Xa 因子抑制剂占 10%（744 名患者），其他抗凝剂（如华法林）占 1.5%（114 名患者）。在对接受化学抗凝治疗的患者进行的子分析中，VTE 的总发生率为 1.1%（7469 例中有 83 例）。考虑到混杂因素，不同类型抗凝剂的 VTE 发生率没有明显差异。大多数化学抗凝药物的术后预防时间为 6 周（64.50%）：结论：研究中报告的化学抗凝剂存在很大差异，使用了五种不同类别的抗凝剂（包括不使用化学抗凝剂），但无明显优劣之分。各类血栓预防药物的抗凝时间是一致的。

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引用次数: 0

Risk factors for 30-day hospital readmission in patients with diabetic foot. 糖尿病足患者 30 天内再次入院的风险因素。

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-06-25 DOI: 10.1016/j.fas.2024.06.003

C A Sánchez, A Galeano, D Jaramillo, G Pupo, C Reyes

Introduction: Diabetic foot (DF) is part of the natural history of diabetes mellitus, ulceration being a severe complication with a prevalence of approximately 6.3 %, which confers a significant economic burden. Hospital readmission in the first thirty (30) days is considered a measure of quality of healthcare and it's been identified that the most preventable causes are the ones that occur in this period. This study seeks to identify the risk factors associated with readmission of patients with DF.

Methods: A case-control study was done by performing a secondary analysis of a database. Descriptive statistics were used for all variables of interest, bivariate analysis to identify statistically significant variables, and a logistic regression model for multivariate analysis.

Results: 575 cases were analyzed (113 cases, 462 controls). A 20 % incidence rate of 30-day readmission was identified. Statistically significant differences were found in relation to the institution of attention (Hospital Universitario de la Samaritana: OR 1.9, p value < 0.01, 95 % CI 1.2-3.0; Hospital Universitario San Ignacio: OR 0.5, p value < 0.01, 95 % CI 0.3-0.8) and the reasons for readmission before 30 days, especially due to surgical site infection (SSI) (OR 7.1, p value < 0.01, 95 % CI 4.1-12.4), sepsis (OR 8.4, p value 0.02, 95 % CI 1.2-94.0), dehiscence in amputation stump (OR 16.4, p value < 0.01, 95 % CI 4.2-93.1) and decompensation of other pathologies (OR 3.5, p value < 0.01, 95 % CI 2.1-5.7).

Conclusion: The hospital readmission rate before 30 days for our population compares to current literature. Our results were consistent with exacerbation of chronic pathologies, but other relevant variables not mentioned in other studies were the hospital in which patients were taken care of, the presence of SSI, sepsis, and dehiscence of the amputation stump. We consider thoughtful and close screening of patients at risk in an outpatient setting might identify possible readmissions.

导言：糖尿病足（DF）是糖尿病自然病程的一部分，溃疡是一种严重的并发症，发病率约为 6.3%，给患者带来了巨大的经济负担。前三十（30）天的再入院率被认为是衡量医疗质量的一个标准，而在此期间发生的再入院率是最可预防的原因。本研究旨在确定与 DF 患者再入院相关的风险因素：方法：通过对数据库进行二次分析，进行病例对照研究。对所有相关变量采用描述性统计，通过双变量分析确定具有统计学意义的变量，并采用逻辑回归模型进行多变量分析：结果：分析了 575 个病例（113 个病例，462 个对照）。结果：分析了 575 个病例（113 个病例，462 个对照组），发现 30 天再入院的发生率为 20%。在统计意义上，与关注机构有关的差异非常明显（萨马里塔纳大学医院：OR 1.9，P值<0.05）：OR值为1.9，P值小于0.01，95 % CI为1.2-3.0；圣伊格纳西奥大学医院：OR值为0.5，P值为0.01：我们的研究对象在 30 天前的再入院率与目前的文献比较一致。我们的研究结果与慢性病加重的情况一致，但其他研究未提及的相关变量包括患者接受治疗的医院、是否存在 SSI、败血症和截肢残端开裂。我们认为，在门诊环境中对有风险的患者进行周到而严密的筛查可能会发现可能的再入院情况。

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引用次数: 0

Comparison of ultrasonographic evaluation methods for ankle syndesmosis in non-weight bearing and weight bearing conditions. 非负重和负重情况下踝关节巩膜超声波评估方法的比较。

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-06-25 DOI: 10.1016/j.fas.2024.06.002

Takuji Yokoe, Fan Yang, Takuya Tajima, Nami Yamaguchi, Yudai Morita, Etsuo Chosa

Background: This study aimed to investigate ankle syndesmosis in healthy subjects under non-weight bearing (NWB) and weight bearing (WB) conditions using two US methods.

Methods: The anterior tibiofibular clear space (ATFCS) was measured in healthy subjects in NWB and WB conditions using two US procedures. Method 1 measured 10 mm above the ankle joint and Method 2 measured 30° from the line of 10 mm above the ankle joint.

Results: A total of 60 ankles from 30 subjects (male/female, 15/15) were included. There was a significant difference in the ATFCS between the two US methods (p < 0.001), and Method 2 was better at detecting the change in diastasis from NWB to WB conditions. The ATFCS was significantly greater on WB than on NWB, irrespective of the US method.

Conclusions: Method 2 was better at detecting diastasis of the syndesmosis from NWB to WB conditions. The influence of WB needs to be considered when evaluating syndesmosis using US.

Level of evidence: Cross-sectional cohort study; Level of evidence, Ⅳ.

背景：本研究旨在使用两种 US 方法研究健康受试者在非负重（NWB）和负重（WB）条件下的踝关节联合：本研究旨在使用两种 US 方法调查健康受试者在非负重（NWB）和负重（WB）条件下的踝关节巩膜情况：方法：采用两种 US 方法测量健康受试者在非负重（NWB）和负重（WB）条件下的胫腓骨前间隙（ATFCS）。方法 1 在踝关节上方 10 毫米处测量，方法 2 从踝关节上方 10 毫米处开始测量 30°：结果：共纳入了 30 名受试者（男性/女性，15/15）的 60 只脚踝。两种 US 方法的 ATFCS 值有明显差异（p 结论：方法 2 更能检测出踝关节的畸形：方法 2 更好地检测了从 NWB 到 WB 条件下的腓骨联合松弛。在使用 US 评估巩膜松弛时需要考虑 WB 的影响：横断面队列研究；证据等级Ⅳ。

{"title":"Comparison of ultrasonographic evaluation methods for ankle syndesmosis in non-weight bearing and weight bearing conditions.","authors":"Takuji Yokoe, Fan Yang, Takuya Tajima, Nami Yamaguchi, Yudai Morita, Etsuo Chosa","doi":"10.1016/j.fas.2024.06.002","DOIUrl":"https://doi.org/10.1016/j.fas.2024.06.002","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate ankle syndesmosis in healthy subjects under non-weight bearing (NWB) and weight bearing (WB) conditions using two US methods.</p><p><strong>Methods: </strong>The anterior tibiofibular clear space (ATFCS) was measured in healthy subjects in NWB and WB conditions using two US procedures. Method 1 measured 10 mm above the ankle joint and Method 2 measured 30° from the line of 10 mm above the ankle joint.</p><p><strong>Results: </strong>A total of 60 ankles from 30 subjects (male/female, 15/15) were included. There was a significant difference in the ATFCS between the two US methods (p < 0.001), and Method 2 was better at detecting the change in diastasis from NWB to WB conditions. The ATFCS was significantly greater on WB than on NWB, irrespective of the US method.</p><p><strong>Conclusions: </strong>Method 2 was better at detecting diastasis of the syndesmosis from NWB to WB conditions. The influence of WB needs to be considered when evaluating syndesmosis using US.</p><p><strong>Level of evidence: </strong>Cross-sectional cohort study; Level of evidence, Ⅳ.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Midterm outcomes of the modified Lapidus arthrodesis using the Phantom® Intramedullary Nail System for the treatment of hallux valgus 使用 Phantom® 髓内钉系统进行改良 Lapidus 关节固定术治疗足外翻的中期疗效。

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-05-31 DOI: 10.1016/j.fas.2024.05.001

Background

Lapidus arthrodesis is one of the most commonly used techniques in the correction of moderate and severe hallux valgus. We analyzed the clinical and radiological outcomes after using the Phantom® Lapidus intramedullary nail to find an effective technique with low complications.

Methods

We retrospectively analyzed data of 52 patients who underwent a modified Lapidus arthrodesis with an intramedullary nail at our center from November 2019 to September 2022. The mean follow-up period was 27 (range, 18–34) months. Clinical results were evaluated using the visual analog scale (VAS), the European Foot and Ankle Society score (EFAS) and the American Orthopaedic Foot and Ankle Society score (AOFAS); three different radiological measures were analyzed.

Results

The mean AOFAS score increased from 44.8 to 82 points. The mean EFAS score increased from 11.2 to 20.1 points. The mean VAS score decreased by 4.7 points. The mean EFAS Sport score was increased from 9.2 (SD 4.6) to 12.6 (SD 5.4) points. The intermetatarsal angle decreased from 15° to 6.9° and the hallux valgus angle by a mean of 17.9°. The forefoot width reduced from 93.6 to 84.7 mm. All results were statistically significant (p < .001). One case of nonunion was recorded. No implant-related complications were observed.

Conclusions

This device was effective in correcting moderate to severe hallux valgus, with significant patient satisfaction. Its complication rate was not higher than that of other fixation devices. Correct compression of the arthrodesis, absence of extraosseous material, and multidirectional stability are important qualities of this implant for the correct treatment of this pathology.

Level of Evidence

Level IV, retrospective case series

背景：Lapidus关节置换术是矫正中度和重度拇指外翻最常用的技术之一。我们分析了使用 Phantom® Lapidus 髓内钉后的临床和放射学结果，以找到一种并发症少的有效技术：我们回顾性分析了2019年11月至2022年9月在本中心接受改良Lapidus髓内钉关节置换术的52名患者的数据。平均随访时间为 27 个月（18-34 个月）。临床结果采用视觉模拟量表（VAS）、欧洲足踝协会评分（EFAS）和美国骨科足踝协会评分（AOFAS）进行评估，并对三种不同的放射学指标进行了分析：结果：AOFAS 的平均得分从 44.8 分上升到 82 分。EFAS平均得分从11.2分上升到20.1分。VAS 平均得分降低了 4.7 分。平均 EFAS 运动得分从 9.2 分（标准差 4.6 分）增加到 12.6 分（标准差 5.4 分）。跖骨间角度从 15°减小到 6.9°，拇指外翻角度平均减小了 17.9°。前足宽度从 93.6 毫米减少到 84.7 毫米。所有结果均具有统计学意义（P 结论：该装置可有效矫正中度足外翻：该装置能有效矫正中度至重度的足外翻，患者满意度很高。其并发症发生率并不比其他固定装置高。关节固定的正确压迫、无骨外材料和多向稳定性是该假体正确治疗该病症的重要品质：证据级别：IV级，回顾性病例系列。

{"title":"Midterm outcomes of the modified Lapidus arthrodesis using the Phantom® Intramedullary Nail System for the treatment of hallux valgus","authors":"","doi":"10.1016/j.fas.2024.05.001","DOIUrl":"10.1016/j.fas.2024.05.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Lapidus arthrodesis is one of the most commonly used techniques in the correction of moderate and severe </span>hallux valgus. We analyzed the clinical and radiological outcomes after using the Phantom® Lapidus intramedullary nail to find an effective technique with low complications.</p></div><div><h3>Methods</h3><p><span>We retrospectively analyzed data of 52 patients who underwent a modified Lapidus arthrodesis with an intramedullary nail at our center from November 2019 to September 2022. The mean follow-up period was 27 (range, 18–34) months. Clinical results were evaluated using the visual analog scale (VAS), the European Foot and Ankle Society score (EFAS) and the American </span>Orthopaedic Foot and Ankle Society score (AOFAS); three different radiological measures were analyzed.</p></div><div><h3>Results</h3><p>The mean AOFAS score increased from 44.8 to 82 points. The mean EFAS score increased from 11.2 to 20.1 points. The mean VAS score decreased by 4.7 points. The mean EFAS Sport score was increased from 9.2 (SD 4.6) to 12.6 (SD 5.4) points. The intermetatarsal angle decreased from 15° to 6.9° and the hallux valgus angle by a mean of 17.9°. The forefoot<span> width reduced from 93.6 to 84.7 mm. All results were statistically significant (p < .001). One case of nonunion was recorded. No implant-related complications were observed.</span></p></div><div><h3>Conclusions</h3><p>This device was effective in correcting moderate to severe hallux valgus, with significant patient satisfaction. Its complication rate was not higher than that of other fixation devices. Correct compression of the arthrodesis, absence of extraosseous material, and multidirectional stability are important qualities of this implant for the correct treatment of this pathology.</p></div><div><h3>Level of Evidence</h3><p>Level IV, retrospective case series</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 7","pages":"Pages 576-581"},"PeriodicalIF":1.9,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison between anterior-to-posterior screw fixation versus posterolateral approach plate fixation for posterior malleous fracture: A systematic review and meta-analysis 后臼齿骨折前后螺钉固定与后外侧入路钢板固定的比较：系统综述与荟萃分析

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-05-22 DOI: 10.1016/j.fas.2024.05.004

Purpose

There are two main surgical fixation methods for the posterior malleolar fractures (PMFs), the anterior-to-posterior (AP) screws or via the posterolateral (PL) approach utilizing a buttress plate. This review aims to compare the clinical outcome between the AP screw fixation and the PL plate fixation for treating PMFs.

Methods

We searched all relevant publications about PMFs treated with AP screws or PL plates through electronic databases including the PubMed, the Cochrane Library, the Embase, the Wiley online library and the Web of Science. The meta-analysis was conducted to evaluated clinical outcomes including reduction quality, post-operative function and complications.

Results

Six studies (one single randomized controlled trial and five retrospective cohort studies) were enrolled. 172 patients underwent AP screw fixation and 214 patients underwent PL plate fixation with a total of 386 patients (169 males and 217 females). The PL plating group yielded better AOFAS scores(MD = 6.97, 95 % CI=[4.68, 9.27], P＜0.00001, I² =0 %) and was more likely to achieve excellent anatomical reduction(OR=5.49, 95 % CI=[1.06, 28.42], P = 0.04, I² =80 %). No differences were found in the bad reduction quality, incidences of complications (arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees.

Conclusion

We suggest that the PL plate fixation method has the clinical benefit of achieving anatomical reduction and better AOFAS scores over the AP screw fixation for treating PMFs. No differences were found in the incidences of complications ( arthritis, neuralgia, superficial wound healing problems and implant failure), the walking VAS scores and the dorsiflexion restriction degrees. The posterior approach and the direct reduction are recommended for the treatment of the PMFs.

Level of Confidence

Ⅱb

目的耳后臼骨骨折（PMFs）主要有两种手术固定方法，一种是前对后（AP）螺钉固定，另一种是通过后外侧（PL）入路使用托板固定。本综述旨在比较AP螺钉固定和PL钢板固定治疗PMF的临床效果。方法我们通过电子数据库（包括PubMed、Cochrane图书馆、Embase、Wiley在线图书馆和Web of Science）检索了所有关于用AP螺钉或PL钢板治疗PMF的相关文献。结果六项研究（一项随机对照试验和五项回顾性队列研究）入选。172名患者接受了AP螺钉固定术，214名患者接受了PL钢板固定术，共计386名患者（男性169名，女性217名）。PL钢板固定组的AOFAS评分更高（MD=6.97，95 % CI=[4.68，9.27]，P＜0.00001，I2 =0%），更有可能获得最佳解剖复位（OR=5.49，95 % CI=[1.06，28.42]，P=0.04，I2 =80%）。结论我们认为，PL钢板固定法比AP螺钉固定法在治疗PMF时具有解剖复位和更好的AOFAS评分的临床优势。在并发症（关节炎、神经痛、表皮伤口愈合问题和植入失败）的发生率、行走 VAS 评分和背伸受限程度方面，均未发现差异。建议采用后路和直接还原法治疗 PMFs。

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引用次数: 0

Survival and complications of transfibular trabecular metal total ankle replacement − A systematic review 经骨小梁金属全踝关节置换术的存活率和并发症 - 系统性综述

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-05-18 DOI: 10.1016/j.fas.2024.05.007

Background

In the past decade, the transfibular approach to Total Ankle Replacement (TAR) has emerged as an alternative to anterior approach with reduced bone resection. The purpose of this systematic review is to report survival, complications, and reoperation rates of transfibular TAR.

Methods

We conducted a systematic search of studies that evaluated complications, reoperations, and survival of transfibular TAR following PRISMA guidelines across PubMed, Scopus and Web of Science.

Results

Our review included data from 12 cohorts, comprising 919 patients across 7 countries, with an average age of 62 years (59% posttraumatic). Over an average follow-up period of 3 years, adverse events occurred in 23% of cases, with 18% requiring surgical reintervention, mostly due to hardware removal. The survival rate of the transfibular TAR metal components was 97% at the final follow-up.

Conclusion

Transfibular TAR demonstrates a 97% survival rate at a 3-year follow-up.

Level of evidence

Level II

背景在过去的十年中，经颌入路全踝关节置换术（TAR）已成为前路置换术的一种替代方法，可减少骨切除。方法我们按照PRISMA指南在PubMed、Scopus和Web of Science上对评估经颌面TAR并发症、再手术和存活率的研究进行了系统检索。结果我们的检索包括来自12个队列的数据，包括7个国家的919名患者，平均年龄62岁（59%为创伤后）。在平均 3 年的随访期内，23% 的病例发生了不良事件，18% 的病例需要重新进行手术干预，其中大部分是由于硬件移除所致。在最后的随访中，颌下TAR金属组件的存活率为97%。

引用次数: 0

Comparison of visibility in needle arthroscopy of the ankle according to surgical experience: A cadaveric study 根据手术经验比较针式踝关节镜检查的可见度：尸体研究

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-05-16 DOI: 10.1016/j.fas.2024.05.005

Background

Literature regarding the feasibility of inexperienced surgeons using needle arthroscopy is limited. The present study aimed to clarify the feasibility of performing ankle needle arthroscopy for inexperienced surgeons.

Methods

Diagnostic needle arthroscopy was performed for 10 cadaveric ankles by two surgeons with different levels of experience in ankle arthroscopy (inexperienced and expert surgeons). The visibility of arthroscopy was assessed based on a 15-point checklist and compared between surgeons. In addition, iatrogenic articular cartilage injury created by the inexperienced surgeon was investigated.

Results

The number of visible points was significantly larger for the expert surgeon than for the inexperienced surgeon (14.1 ± 1.0 vs. 13.7 ± 1.0, P = 0.035). The location of cartilage injury was greatest on the medial talar dome when viewing from the anteromedial portal at a rate of 30%.

Conclusion

Ankle needle arthroscopy may be an option for surgeons in the future, however, differences in surgeon experience may impact effective visualization.

背景有关经验不足的外科医生使用针式关节镜的可行性文献有限。本研究旨在阐明经验不足的外科医生进行踝关节针关节镜检查的可行性。方法由两名在踝关节镜检查方面具有不同经验的外科医生（经验不足的外科医生和专家外科医生）对 10 个尸体踝关节进行诊断性针刺关节镜检查。根据 15 点核对表对关节镜检查的可视性进行评估，并在外科医生之间进行比较。此外，还对缺乏经验的外科医生造成的先天性关节软骨损伤进行了调查。结果专家外科医生的可见点数明显多于缺乏经验的外科医生（14.1 ± 1.0 vs. 13.7 ± 1.0，P = 0.035）。结论踝针关节镜检查可能是外科医生未来的一个选择，然而，外科医生经验的差异可能会影响有效的可视化。

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引用次数: 0

Retromalleolar groove morphology of the tibialis posterior tendon (TPT) in patients without TPT pathology evaluated by axial computed tomography scans 通过轴向计算机断层扫描评估无胫骨后肌腱（TPT）病变患者的胫骨后肌腱（TPT）后沟形态。

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery

Pub Date : 2024-05-15 DOI: 10.1016/j.fas.2024.05.006

Background

This study aimed to evaluate the shape of the retromalleolar groove of the tibialis posterior tendon (TPT) using computed tomography (CT).

Methods

CT images of patients with foot or ankle pathologies were retrospectively reviewed. The morphology of the retromalleolar groove of the TPT was assessed at two different levels: the ankle joint and 10 mm above the ankle joint. The groove shape was classified into three types; concave, flat, or irregular. In cases with concave grooves, the width and depth of the grooves were measured.

Results

Of the 116 ankles from 116 subjects included in this study, 80.2 % showed a shallow concave shape (mean depth, 1.6 mm) at the two scan levels. The shape and width of the groove differed significantly by gender, although there was no significant difference in the groove depth.

Conclusion

Approximately 80% showed a shallow concave groove of the TPT. The groove characteristics differed by gender, although there was no significant difference in the groove depth.

Level of evidence

Cross-sectional cohort study; Level of evidence, Ⅳ

背景：本研究旨在使用计算机断层扫描（CT）评估胫骨后肌腱（TPT）的后腓侧沟形状：本研究旨在使用计算机断层扫描（CT）评估胫骨后肌腱（TPT）后腓侧沟的形状：方法：对足部或踝部病变患者的 CT 图像进行回顾性审查。在踝关节和踝关节上方 10 毫米处的两个不同水平评估了胫骨后肌腱后侧沟的形态。凹槽形状分为三种类型：凹形、扁平形或不规则形。在凹陷沟槽的情况下，测量沟槽的宽度和深度：结果：在 116 名受试者的 116 个脚踝中，80.2% 在两个扫描层面上显示出浅凹形（平均深度为 1.6 毫米）。尽管凹槽深度没有明显差异，但凹槽的形状和宽度在性别上存在显著差异：结论：约 80% 的 TPT 显示浅凹槽。结论：约 80% 的 TPT 显示浅凹槽，不同性别的凹槽特征不同，但凹槽深度无明显差异：证据等级：横断面队列研究；证据等级Ⅳ。

{"title":"Retromalleolar groove morphology of the tibialis posterior tendon (TPT) in patients without TPT pathology evaluated by axial computed tomography scans","authors":"","doi":"10.1016/j.fas.2024.05.006","DOIUrl":"10.1016/j.fas.2024.05.006","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to evaluate the shape of the retromalleolar groove of the tibialis posterior tendon (TPT) using computed tomography (CT).</p></div><div><h3>Methods</h3><p>CT images of patients with foot or ankle pathologies were retrospectively reviewed. The morphology of the retromalleolar groove of the TPT was assessed at two different levels: the ankle joint and 10 mm above the ankle joint. The groove shape was classified into three types; concave, flat, or irregular. In cases with concave grooves, the width and depth of the grooves were measured.</p></div><div><h3>Results</h3><p>Of the 116 ankles from 116 subjects included in this study, 80.2 % showed a shallow concave shape (mean depth, 1.6 mm) at the two scan levels. The shape and width of the groove differed significantly by gender, although there was no significant difference in the groove depth.</p></div><div><h3>Conclusion</h3><p>Approximately 80% showed a shallow concave groove of the TPT. The groove characteristics differed by gender, although there was no significant difference in the groove depth.</p></div><div><h3>Level of evidence</h3><p>Cross-sectional cohort study; Level of evidence, Ⅳ</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"30 7","pages":"Pages 608-611"},"PeriodicalIF":1.9,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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