中国修复重建外科杂志

中国修复重建外科杂志

全踝关节置换术治疗晚期踝关节炎研究进展

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目的 总结全踝关节置换术(total ankle arthroplasty,TAA)治疗晚期踝关节炎(ankle osteoarthritis,AOA)的研究进展。 方法 查阅近年国内外相关文献,从传统 TAA 手术效果、计算机辅助 TAA 临床应用等方面,对目前 TAA 的现状及进展进行总结。 结果 晚期 AOA 常导致患者严重疼痛和功能障碍,踝关节融合仍是目前主要治疗方案。近年来,随着手术技术和假体设计的进步,保留关节活动度的 TAA 病例逐年增加,手术效果也取得明显进步。精确的假体安置和力线恢复对 TAA 至关重要,手术相关的踝关节置换力线不良是影响假体寿命的重要因素。计算机辅助个体化设计导板可以简化关节置换操作难度,满足胫骨和距骨截骨的精准度。 结论 基于术前 CT 的个体化导板技术,其临床效果有待进一步随访观察;同时需要进一步开发适合 TAA 的术中导航和机器人手术系统。

Objective To review the progress of total ankle arthroplasty (TAA) in treatment of end-stage ankle osteoarthritis (AOA). Methods The domestic and foreign literatures about TAA in recent years were reviewed. The current status and progress of TAA were summarized from the results of traditional and computer-assisted TAA clinical outcomes. Results End-stage AOA often leads to severe pain and dysfunction, and arthrodesis is still the main selective treatment option. In recent years, with the advancement of surgical techniques and prosthesis design, TAA which can remain joint mobility has increased gradually, and the surgical results also have significant progress. Accurate prosthesis implant and mechanical alignment restoration are critical factors for TAA, and surgery-related malalignment is correlative to the prosthesis failure. Computer assisted patient-specific guide can simplify the TAA procedures and obtain the accuracy of tibia and talus osteotomy. Conclusion The clinical efficiency of preoperative CT based patient-specific guide technology for TAA needs further clinical follow-up. Meanwhile, it is necessary to further develop intraoperative navigation and robotic surgery system suitable for TAA.

关键词: 踝关节炎; 全踝关节置换术; 假体; 力线; 个体化导板

Key words: Ankle osteoarthritis; total ankle arthroplasty; prosthesis; alignment; patient-specific guide

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