대한족부족관절학회지 (Journal of Korean Foot and Ankle Society)

  • 제21권3호
  • /
  • Pages.98-103
  • /
  • 2017
  • /
  • 1738-3757(pISSN)
  • /
  • 2288-8551(eISSN)
대한족부족관절학회 (Korean Foot & Ankle Society)
권호 표지
DOI QR코드

DOI QR Code

경거골유합술 후 발생하는 불유합과 관련된 인자에 대한 분석

Analysis about Associated Factors of Nonunion Following Tibiotalar Arthrodesis

  • 이준영 (조선대학교 의과대학 정형외과학교실) ;
  • 김보선 (조선대학교 의과대학 정형외과학교실) ;
  • 이정우 (조선대학교 의과대학 정형외과학교실)
  • Lee, Jun Young (Department of Orthopaedic Surgery, College of Medicine, Chosun University) ;
  • Kim, Bo Sun (Department of Orthopaedic Surgery, College of Medicine, Chosun University) ;
  • Lee, Jung Woo (Department of Orthopaedic Surgery, College of Medicine, Chosun University)
  • 투고 : 2017.05.19
  • 심사 : 2017.07.21
  • 발행 : 2017.09.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The aim of this study was to analyze the factors related to nonunion in tibiotalar arthrodesis. Materials and Methods: Eighty cases of ankle arthritis treated with tibiotalar arthrodesis in our hospital from November 2008 to November 2015 with more than one year follow up were analyzed. Simple anteroposterior and lateral radiographs after 6 and 12 months of surgery were analyzed. Union was defined as more than 50% connection of the trabecular bone at the ankle joint surface in the anteroposterior and lateral radiographs. The nonunion group was defined as no signs of union with persistent pain 9 months after surgery. The surgical approach, type of used screw, preoperative and postoperative ankle alignment, body mass index (BMI), bone mineral density, and patients' prior history were compared between the two groups. Results: There were 69 union cases and 11 nonunion cases. In the patient factors, the gender and BMI was related to nonunion (p<0.05). The mean preoperative and postoperative ankle alignment in the nonunion group was $9.93^{\circ}{\pm}6.92^{\circ}$ and $5.43^{\circ}{\pm}3.35^{\circ}$ respectively, and $9.80^{\circ}{\pm}7.55^{\circ}$ and $5.63^{\circ}{\pm}3.45^{\circ}$ in the union group, respectively; the difference was not statistically significant (p>0.05). In the technical factors, the transfibular approach showed a better relationship but the association was not significant (p<0.05). In 40 cases of the transfibular approach, 12 cases used cancellous screws, and 4 cases showed nonunion due to screw breakage. Conclusion: Technical factors, such as the surgical approach and the type of screw used can be a risk factor in nonunion. In addition, patients' factors, such as gender and BMI, must be considered to reduce the nonunion rate.

키워드

참고문헌

  1. Gordon D, Zicker R, Cullen N, Singh D. Open ankle arthrodeses via an anterior approach. Foot Ankle Int. 2013;34:386-91. https://doi.org/10.1177/1071100713477385
  2. Maurer RC, Cimino WR, Cox CV, Satow GK. Transarticular cross-screw fixation. A technique of ankle arthrodesis. Clin Orthop Relat Res. 1991;(268):56-64.
  3. Stranks GJ, Cecil T, Jeffery IT. Anterior ankle arthrodesis with cross-screw fixation. A dowel graft method used in 20 cases. J Bone Joint Surg Br. 1994;76:943-6.
  4. Raikin SM. Arthrodesis of the ankle: arthroscopic, mini-open, and open techniques. Foot Ankle Clin. 2003;8:347-59. https://doi.org/10.1016/S1083-7515(03)00014-7
  5. Akra GA, Middleton A, Adedapo AO, Port A, Finn P. Outcome of ankle arthrodesis using a transfibular approach. J Foot Ankle Surg. 2010;49:508-12. https://doi.org/10.1053/j.jfas.2010.07.004
  6. Holt ES, Hansen ST, Mayo KA, Sangeorzan BJ. Ankle arthrodesis using internal screw fixation. Clin Orthop Relat Res. 1991;(268):21-8.
  7. Monroe MT, Beals TC, Manoli A 2nd. Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws. Foot Ankle Int. 1999;20:227-31. https://doi.org/10.1177/107110079902000404
  8. Kennedy JG, Hodgkins CW, Brodsky A, Bohne WH. Outcomes after standardized screw fixation technique of ankle arthrodesis. Clin Orthop Relat Res. 2006;447:112-8. https://doi.org/10.1097/01.blo.0000203480.04174.0e
  9. Nielsen KK, Linde F, Jensen NC. The outcome of arthroscopic and open surgery ankle arthrodesis: a comparative retrospective study on 107 patients. Foot Ankle Surg. 2008;14:153-7. https://doi.org/10.1016/j.fas.2008.01.003
  10. Charnley J. Compression arthrodesis of the ankle and shoulder. J Bone Joint Surg Br. 1951;33B:180-91.
  11. Morrey BF, Wiedeman GP Jr. Complications and long-term results of ankle arthrodeses following trauma. J Bone Joint Surg Am. 1980;62:777-84. https://doi.org/10.2106/00004623-198062050-00012
  12. Kenzora JE, Simmons SC, Burgess AR, Edwards CC. External fixation arthrodesis of the ankle joint following trauma. Foot Ankle. 1986;7:49-61. https://doi.org/10.1177/107110078600700108
  13. Frey C, Halikus NM, Vu-Rose T, Ebramzadeh E. A review of ankle arthrodesis: predisposing factors to nonunion. Foot Ankle Int. 1994;15:581-4. https://doi.org/10.1177/107110079401501102
  14. White AA 3rd. A precision posterior ankle fusion. Clin Orthop Relat Res. 1974;(98):239-50.
  15. Scranton PE Jr. Use of internal compression in arthrodesis of the ankle. J Bone Joint Surg Am. 1985;67:550-5. https://doi.org/10.2106/00004623-198567040-00008
  16. Loughlin J. Genetic epidemiology of primary osteoarthritis. Curr Opin Rheumatol. 2001;13:111-6. https://doi.org/10.1097/00002281-200103000-00004
  17. Adams JC. Arthrodesis of the ankle joint; experiences with the transfibular approach. J Bone Joint Surg Br. 1948;30B:506-11.
  18. Mann RA, Rongstad KM. Arthrodesis of the ankle: a critical analysis. Foot Ankle Int. 1998;19:3-9. https://doi.org/10.1177/107110079801900102
  19. Wang GJ, Shen WJ, McLaughlin RE, Stamp WG. Transfibular compression arthrodesis of the ankle joint. Clin Orthop Relat Res. 1993;(289):223-7.
  20. O'Brien TS, Hart TS, Shereff MJ, Stone J, Johnson J. Open versus arthroscopic ankle arthrodesis: a comparative study. Foot Ankle Int. 1999;20:368-74. https://doi.org/10.1177/107110079902000605
  21. Schutz M, Ruedi TP. Principles of internal fixation. In: Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P III, editors. Rockwood and Green's fractures in adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p.162-90.
  22. Kish G, Eberhart R, King T, Holzaepfel JL, Pollock T. Ankle arthrodesis placement of cannulated screws. Foot Ankle. 1993;14:223-4. https://doi.org/10.1177/107110079301400408
  23. Pak CH, Lee JY, Jeong YJ. Ankle arthrodesis outcomes in ankle osteoarthritis: comparison between anterior approach and transfibular approach. J Korean Foot Ankle Soc. 2014;18:189-94. https://doi.org/10.14193/jkfas.2014.18.4.189
  24. Ogilvie-Harris DJ, Lieberman I, Fitsialos D. Arthroscopically assisted arthrodesis for osteoarthrotic ankles. J Bone Joint Surg Am. 1993;75:1167-74. https://doi.org/10.2106/00004623-199308000-00006
  25. Goetzmann T, Mole D, Jullion S, Roche O, Sirveaux F, Jacquot A. Influence of fixation with two vs. three screws on union of arthroscopic tibio-talar arthrodesis: comparative radiographic study of 111 cases. Orthop Traumatol Surg Res. 2016;102:651-6. https://doi.org/10.1016/j.otsr.2016.03.015