Anterior ankle fusion

The ankle joint is the main weight-bearing joint in the body, and its activity is mainly the flexion of the ankle. However, the abduction and abduction of the subtalar joint and the rotation of the ankle and ankle joint also affect the activity of the ankle joint on the coronal plane. At present, the design of the ankle joint prosthesis does not meet the requirements of biomechanics. The long-term effect of ankle arthroplasty is not satisfactory, and the ankle joint can still work and walk normally after fusion. The ankle joint fusion is generally in the neutral position of 90°. Because the forefoot has sufficient flexor and dorsal extension muscle strength and the compensation of the intercondylar joint, the forefoot extension can leave the ground when walking, and the plantar flexor muscle is strong and obtains a stable gait. . Some people advocate that the fusion is at 95° to compensate for the shortening of the articular cartilage surface after resection, and it is more convenient to wear the shoes with the heel. However, excessive grievance will produce forefoot and claudication, which is integrated in the back extension (rear toe), the foot can not be leveled, and there is no driving force, just like the gait of a patient with a prosthetic leg. The ideal ankle joint fusion position is 90° flexion, 5° valgus, 5-10° external rotation and the choice of functional position should include the full evaluation of the limb condition, ie the foot and the lower limb. The limb shortening should be integrated in the appropriate flexion position. Quadriceps tendon or weakness is contraindicated in the dorsiflexion. There are many methods for the ankle joint fusion. The surgical design should be based on the patient's specific conditions, with or without secondary malformation. The surgical procedure and approach of tuberculous and non-tuberculous arthritis are different. For example, severe plantar deformity should be performed simultaneously with Achilles tendon extension. The fascia fascia is cut, the posterior capsule of the ankle is incision, and the posterior tibial nerve vessels are released. Treatment of diseases: ankle joint dislocation ankle fracture Indication The anterior incision is superficial, clear and easy to operate. The anterior ankle arthrodesis is suitable for patients with a small distal joint without deformity and a very varus deformity. Contraindications It is not suitable for patients with ankle joint tuberculosis, clubfoot and severe plantar flexion with joint stiffness. Surgical procedure Incision The anterior median incision was made with the ankle joint as the center. It was 6 cm from the iliac crest and extended to the 2nd or 3rd cuneiform bone before the iliac crest. The length was 10 to 12 cm. If there is a wavy incision in the deformity of the plantar deformity, it is convenient to suture the skin after the deformity is corrected. 2. Exposing the joint Cut the calf extensor support band and the anterior cruciate ligament, and pull the anterior tibial tendon to the medial side. The long tendon, the anterior tibial artery, and the long toe of the toe are pulled outward to reveal the lower end of the humerus and the ankle joint, or the long toe and extension of the toe from the lateral side. The long tendon is retracted together with the blood vessels, and the periosteum and joint capsule of the lower end of the humerus are cut. The subperiosteal dissection reveals the lower end of the humerus, the ankle joint and the tibia. 3. Articular surface resection and joint fusion The periosteal stripper was placed along the medial aspect of the humerus to protect the posterior iliac crest nerve. The iliac articular cartilage surface was excised horizontally from the tibia with a bone knife. The internal and external ankle surface was removed, and then parallel to the tibia. The talus articular cartilage surface was removed (corrected deformity) The bone surface should be removed according to the preoperative plan, so that the 90° bone end is in close contact. A rectangular full-thick cortical piece 5 cm long and 2 cm wide is cut in front of the lower end of the humerus. Blair, Morris et al. advocated the talus body defect or sterile necrosis to remove the talus body, and drill a bone groove on the talar neck and the corresponding part of the bone piece to maintain the sacral neutral position, and insert the bone piece into the groove, the upper screw 1~2 The root is fixed on the tibia and talus. If the talus is removed, a single Sterling needle is inserted from the calcaneus to the tibia to stabilize. 4. Arthroscopy-assisted ankle arthrodesis Minimally invasive surgery with arthroscopy-assisted ankle arthrodesis, less trauma, less pain, clear vision, less interference to tissues around the ankle joint, no damage to local tissue structure and blood supply, no loss of articular cartilage, and benefit of bone Fusion, its efficacy is exact. (1) Before the operation, the ankle bone mark, the vascular nerve and the anterior and posterior external arthroscopic entrance mark of the axillary point. The patient was placed in the supine position. The anterior and posterolateral approach of the ankle joint was routinely performed. The skin was sharply incised 4 mm. The hemostatic forceps were used to separate the subcutaneous tissue. The blunt puncture cone and sleeve were inserted into the joint cavity, and the arthroscope was placed. Arthroscopy. (2) Using a planing knife and a plasma knife to clean the synovial tissue and fibrous scar tissue of hyperplasia, hypertrophy, congestion and edema. Grind the anterior lip of the tibia and remove the cartilage surface of the humerus and the cartilage at the top of the talus. If necessary, use a micro bone knife or curette to clean the articular surface, clean the cartilage and subchondral bone of the internal and external axillary points, and expose the cancellous bone. And bleeding. (3) The Kirschner wire is inserted through the heel-to-orbital or sacral-distal joint. After confirming the position through the C-arm X-ray machine, the hollow screw is screwed along the guide pin. The two screws are simultaneously pressed and fixed to ensure that the ankle-to-synthesis is in close contact for bone fusion. Autologous bone or allogeneic bone grafting can also be performed. The cancellous bone is implanted into the joint cavity under the arthroscopy monitoring through the cannula, and the bone defect area is filled, and the embedded rod is pressed and pressed tightly. 5. Fixed "Holt", do not do bone plate chute, advocate traumatic arthritis -arthritic screw fixation, sacral flexion from the axillary point to the proximal side of the humerus, small incision in the skin of the posterolateral cortex of the humerus, drill bit reverse Come back to the original road back, squat dorsiflexion 90 ° drill bit continues to advance to the talar neck screw. The second screw is cross-fixed in front of the tibia, and the outer iliac is reinforced with a third screw when necessary. The fusion of Ilizarov's external fixation frame is more suitable for the skin defect of the foot-stained wound, and the operation is the same as above.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.