| Part One Comparisons between ankle distraction arthroplasty and supramalleolar osteotomy for treatment of post-traumatic varus ankle osteoarthritisObjective: This article aims to retrospectively analyze the clinical case data of patients with post-traumatic varus ankle arthritis(VAA)in our hospital,discuss the curative effect of ankle joint distraction arthroplasty and suprama-lleolar osteotomy onpost-traumatic VAA,and conduct a comparative study to provide reference for clinical work.Methods: This was a retrospective study,comprising 73 consecutive patients who presented with Takakura-Tanaka stage 3 post-traumatic VAA treated by either ankle distraction arthroplasty(n=32)or supramalleolar osteotomy(n=41)from January 2016 to January 2020.Including 46 males and27 females,with an average age of 54.7±12.8 years.One month,three months,six months and one year after operation,all patients were followed up in the outpatient department.The outcome measures were visual analog scale(VAS),the American Orthopedic Foot & Ankle Society(AOFAS)anklehindfoot scores,complications,patient-rated overall satisfaction and ankle function.The preoperative and postoperative correction of tibial anterior surface angle(TAS),tibial lateral surface angle(TLS),talar tilt angle(TT)were measured and compared by imaging results,and the postoperative complications were recorded in detail;At the last follow-up,the patient’s satisfaction was evaluated according to the comprehensive surgical effect.Result: At an average of 32.8 months(range,24 to 52 months)follow-up,significant improvement was observed for VAS,AOFAS,range of motion(ROM)and most radiographic parameters(except for TAS and TLS for ankle distraction arthroplasty group)compared to preoperative baselines(P<0.05)for both groups.However,both groups did not differ significantly in terms of VAS or AOFAS,excellent and good rate(78.1% versus 85.4%,P=0.422),overall rate of postoperative complications(28.1% vs 17.1%,P=0.257),or various radiographic parameters(e.g.tibial anterior surface angle,talar tilt angle and tibial lateral surface angle)(all P>0.05).The ankle distraction arthroplasty group had a better postoperative ankle motion than did the supramalleolar osteotomy group,in terms of plantarflexion(37.8±4.2 vs30.4±3.6,P=0.006),dorsiflexion(19.4±1.2 vs 18.5±1.8,P=0.018),varus(32.1±4.5 vs 27.1±3.1,P=0.017)and valgus(13.6±1.0 vs 12.9±1.1,P=0.007).Conclusion: Both operative treatments are effective for TakakuraTanaka stage 3 post-traumatic VAA,alleviate the symptoms of ankle arthritis,and improve the quality of life of patients.After the external fixator ankle joint distraction arthroplasty,the range of motion of the ankle joint can be improved to a greater extent,while the supramalleolar osteotomy group has more efforts to correct varus deformity.In practice,individualized treatment option tailored to the ankle condition and patients’ specific need should be considered.Part Two Effect analysis of different supramolar osteotomy in the treat-ment of ankle osteoarthritisObjective: The purpose of this study is to evaluate effect of different supramolar osteotomy in the treatment of asymmetrical ankle arthritis,and to conduct a comparative study on the postoperative effects.Method: This retrospective study included 60 consecutive patients with ankle arthritis who underwent surgery from January 2015 to December 2020.Including 35 males and 25 females,Age from 35 to 70 years,with an average age of 53.7±8.7 years.According to Takakura Tanaka ankle arthritis classification: 25 cases in stage 2,35 cases in stage 3(17 cases in stage 3a,18 cases in stage 3b).25 patients received traditional supramalleolar osteotomy,18 patients underwent supramalleolar oblique osteotomy,17 patients underwent Dome osteotomy.All patients were followed up in the outpatient department after surgery,and the VAS score,AOFAS score and Maryland score were recorded,the changes of ankle pain symptoms and the improvement of ankle function were evaluated according to the criteria of the ankle osteoarthritis scale(AOS).The ankle joint activity of patients before and after operation was compared.The preoperative and postoperative correction of TAS,TLS,TT,TC were measured and compared by imaging results.According to the recovery after surgery,the patient made subjective satisfaction evaluation on the perioperative situation.Results: Three groups of patients were followed up for an average of 32.2±14.4 months(12~62 months),and all obtained satisfactory clinical results.At the last follow-up,all patients achieved bony union at the osteotomy site,and there were no patients with nonunion;The VAS score,AOFAS score,Maryland score,AOS pain and function score and ankle joint range of motion of the three groups were significantly improved compared with those before operation(P<0.05),but there was no significant difference among the three groups(P>0.05).The TLS of the patients in the traditional supramalleolar osteotomy group and oblique osteotomy group were not significantly improved compared with those before the operation(P>0.05),and the TAS,TT,TC were significantly improved compared with those before the operation;The imaging angle of Dome osteotomy group was better than that before operation.The Takakura-Tanaka stage of patients with ankle arthritis improved significantly compared with preoperative stage(P<0.05).The three groups of patients had different complications after operation,the total incidence of complications was not significantly different.The common complications were mild infection of the incision,healing after dressing change.One patient with traditional supramalleolar osteotomy and one patient with oblique osteotomy still suffered from ankle pain after operation,and finally underwent ankle arthrodesis.Conclusion: Three different methods of supramalleolar osteotomy is effective in the treatment of Takakura-Tanaka stage 2 and stage 3 ankle arthritis.Preoperative physical examination and imaging examination should be fully improved.According to the soft tissue condition around the ankle joint,the surgical indication should be strictly controlled,and the most appropriate osteotomy method should be provided for the patient according to the patient’s age,symptoms,stage of ankle arthritis and surgical needs. |
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