거골하 유합술 시 전방 및 후방 관절면 고정술식과 후방 관절면 단독 고정술식의 비교
Comparison of Posterior Fixation Technique and Anterior-Posterior Fixation Technique in Subtalar Arthrodesis
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Purpose: Subtalar arthrodesis has been the gold standard for the painful subtalar joint disorders. Successful subtalar arthrodesis requires fusion of the 3 facet joints. The purpose of the study is to compare the clinical outcome of the posterior fixation (P2) and anterior-posterior (A1P1) fixation technique for subtalar arthrodesis which enhance anterior and middle facet fixation. Materials and Methods: The study is based on the 20 feet (19 patients) of the subtalar arthrodesis utilizing cannulated screws from September 2006 to September 2009 with at least 1-year follow-up. Two fixation techniques were utilized for the subtalar arthrodesis: 1) posterior fixation only (P2, 7 feet, 35%) and 2) anterior-posterior (A1P1) fixation method (13 feet, 65%). Visual Analog Scale Pain (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (maximum: 94points), the time for returning to daily living and the patient satisfaction were also evaluated. Results: Average follow-up period were 13.2 months (12-3 mo). The AOFAS score improved from preoperative average 45 (0-68)to 81.6 (62-94), while VAS score was decreased from average 8.0 (3-10) to 1.8 (0-5) at final follow-up. Ninety-five percent of the patients were satisfied with surgery. All the patients returned to daily living at average 7.2 months (2-15 mo) post-surgery. Radiographically, 2 techniques both showed 100% fusion of the posterior compartment of the subtalar joint. Postoperative complications were 1 case of low grade infection and 1 case of sural nerve neuralgia. Conclusion: The subtalar arthrodesis using A1P1 fixation technique showed better fusion rate of the anterior compartment of the subtalar joint compared to P2 fixation technique although the 2 techniques both showed similar favorable clinical outcome. Therefore the A1P1 fixation technique is found to be a viable option to address chronic painful subtalar joint disorders to enhance the anterior compartment fixation.
Abstract
Purpose: Subtalar arthrodesis has been the gold standard for the painful subtalar joint disorders. Successful subtalar arthrodesis requires fusion of the 3 facet joints. The purpose of the study is to compare the clinical outcome of the posterior fixation (P2) and anterior-posterior (A1P1) fixation technique for subtalar arthrodesis which enhance anterior and middle facet fixation. Materials and Methods: The study is based on the 20 feet (19 patients) of the subtalar arthrodesis utilizing cannulated screws from September 2006 to September 2009 with at least 1-year follow-up. Two fixation techniques were utilized for the subtalar arthrodesis: 1) posterior fixation only (P2, 7 feet, 35%) and 2) anterior-posterior (A1P1) fixation method (13 feet, 65%). Visual Analog Scale Pain (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (maximum: 94points), the time for returning to daily living and the patient satisfaction were also evaluated. Results: Average follow-up period were 13.2 months (12-3 mo). The AOFAS score improved from preoperative average 45 (0-68)to 81.6 (62-94), while VAS score was decreased from average 8.0 (3-10) to 1.8 (0-5) at final follow-up. Ninety-five percent of the patients were satisfied with surgery. All the patients returned to daily living at average 7.2 months (2-15 mo) post-surgery. Radiographically, 2 techniques both showed 100% fusion of the posterior compartment of the subtalar joint. Postoperative complications were 1 case of low grade infection and 1 case of sural nerve neuralgia. Conclusion: The subtalar arthrodesis using A1P1 fixation technique showed better fusion rate of the anterior compartment of the subtalar joint compared to P2 fixation technique although the 2 techniques both showed similar favorable clinical outcome. Therefore the A1P1 fixation technique is found to be a viable option to address chronic painful subtalar joint disorders to enhance the anterior compartment fixation.
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