Ankle arthrodesis

Definition/Description(edit|edit source]

Ankle arthrodesis, also commonly referred to as joint fusion, is a surgical procedure which fuses the bones that form the ankle joint, essentially eliminating the joint. Ankle arthrodesis has remained the gold standard treatment for symptomatic primary, secondary and posttraumatic ankle arthritis^[1](2]

Indication for Procedure(edit|edit source]

长期有症状的踝关节病的患者严重受损，以至于通常的疼痛管理技术失败是关节固定术的候选者。一旦保守措施失败，应考虑手术。^(2](3](4]

Following indications could make patients suitable to an ankle arthrodesis^(2](4]:

• Posttraumatic and primary Arthrosis
• Neuromuscular deformity
• Revision of Failed Ankle Arthrodesis
• 全踝关节置换失败
• Avascular Necrosis of theTalus (requiring tibiocalcaneal arthrodesis)
• Neuroarthropathy (Charcot)
• Rheumatoid Arthritis with severe deformity
• Osteoarthritis
• Pseudarthrosis

Ankle Arthrodesis should not be used if following conditions are present^(2](4]:

• Severe vascular deficiency
• Osteomyelitis or soft tissue infection
• Acute purulent infection
• Total avascular necrosis of the talus
• Severe peripheral arterial occlusive disease

Physical Therapy Management(edit|edit source]

正如只有在保守措施失败的过程中所提到的，应考虑手术。这些保守的治疗方法包括药物，支撑，矫形器管理，修饰鞋子和类固醇的关节内应用。^(2](3](5].

Relevant information the post-operative procession^(3](6]:

• Immediately after the surgery, the patient will receive a wide cast covererd by a gauze dressing. Occasionally the cast needs to be decompressed, since post-operative swelling of the ankle may occure.
• Patient will be prescribed three days of bed rest.
• The initial cast is changed to a second cast at two weeks postoperative.
• After 2 months the initial cast is replaced by a weightbearing one and x-rays are taken. This implicates that weightbearing is not allowed for at least two months after operation. Only about 11 week after the operation full ankle loading is approached.
• Over a period of approximately 3 months patient will use crutches, in order to ease the ankle in its weightbearing.
• 在三到四个月时，将转换为可移动的步行者靴，并卸下销钉/螺钉。
• It will take about four months in order to make transition to a shoe.

Based on a guideline provided by the Balance Orthopaedic Foot and Ankle Center of Long Beach, physical therapy approach after ankle arhtrodesis will emphasize maximizing residual motion, strengthening the lower extremity, and in the later phases of physical therapy, emphasis will be placed on developing maximum smoothness of walking (gait). The guideline suggest to start with isometric excercises as soon as possible, on the day of the surgery.

参考(edit|edit source]