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題 名 | Hindfoot Arthrodesis for Neuropathic Deformity=神經病變併後足畸形的融合手術治療 |
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作 者 | 黃鵬如; 傅尹志; 盧政昌; 吳汶蘭; 鄭裕民; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 23:3 2007.03[民96.03] |
頁 次 | 頁120-127 |
分類號 | 416.61 |
關鍵詞 | 踝融合; 神經病變; 脛距跟骨融合; Ankle arthrodesis; Neuropathy; Tibiotalocalcaneal arthrodesis; |
語 文 | 英文(English) |
中文摘要 | 後天性足神經病變會造成關節炎、畸形、關節不穩定和功能受限。現今後足融合手術仍用來治療這些無法復位而且無法穿戴輔具的神經病變畸形足,雖然高未癒合率與高併發症有報告過。從 1990 年到 2001 年,共有 17 個後天神經病變畸形足接受治療,其中 4 個接受脛距跟骨融合,13 個接受踝融合。脛距跟骨融合用于踝關節與距下關節皆有關節炎侵犯。所有脛距跟骨融合病人都未發生未癒合情形,13 個踝融合病人則有 7 個發生未癒合,對於這 7 個病人,我們在 2 個病人用脛距跟骨融合治療,在 5 個病人用再一次踝關節融合治療。最後,2 個脛距跟骨融合有一個未癒合,而踝關節再融合也有一個未癒合。最終融合率是 88% (15/17),平均所需癒合時間是 6–9 個月 (2.5 到 18 個月),依照美國足踝關節學會踝後足評估表來看,有一個是優 (excellent),有 7 個是好 (good),有 8 個是一般 (fair),有 1 個是不良 (poor)。後足畸形併神經病變的融合手術治療,若踝關節與距下關節都有侵犯,則適用脛距跟骨融合治療,若距下關節還完好,則適用踝關節融合治療,若踝關節融合失敗,脛距跟骨融合治療並非唯一選擇。可嘗試再一次踝關節融合,但若距骨磨損破裂變小,則脛距跟骨融合會是比較合適的選擇。 |
英文摘要 | Acquired neurologic disorders of the foot lead to arthrosis, deformities, instabilities, and functional disabilities. Hindfoot arthrodesis is the current option available for irreducible or nonbraceable deformities of neuropathic feet. However, the role of ankle arthrodesis in these patients has been questioned because of high nonunion and complication rates. From 1990 to 2001, 17 cases of acquired neuropathic foot deformities were treated by four tibiotalocalcaneal (TTC) arthrodeses and 13 ankle arthrodeses. TTC arthrodesis was performed on cases with combined ankle and subtalar arthritis or cases whose deformities or instabilities could not be corrected by ankle fusion alone. There was no nonunion of TTC arthrodesis and seven ununited ankle arthrodeses were salvaged by two TTC-attempted arthrodeses and five revision ankle-attempted arthrodeses. Eventually in these cases, there was one nonunion in TTC arthrodesis and one nonunion in revision ankle arthrodesis. The final fusion rate was 88% (15 of 17 cases) with average union time of 6.9 months (range, 2.5–18 months). The American Orthopaedic Foot and Ankle Society ankle hindfoot functional scores were evaluated: one was excellent (5.8%), seven were good (41%), eight were fair (53.3%), and one was poor (5.8%) in terms of total functional outcome. We conclude that TTC arthrodesis is indicated for cases with ankle and subtalar involvement and ankle arthrodesis is an alternative for cases with intact subtalar joint. We recommend revision ankle arthrodesis if the ankle fails to fuse and the bone stock of the talus is adequate. TTC arthrodesis is reserved for ankles with poor bone stock of the talus with fragmentation. |
本系統中英文摘要資訊取自各篇刊載內容。