Die tibiotalokalkaneare Arthrodese mit einem winkelstabilen Marknagel mit Rückfußvalgus und Kompressionsmöglichkeit

 

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Zusammenfassung

Studienziel: Ziel dieser Studie war es, die mittelfristigen Ergebnisse nach tibiotalokalkanearer Arthrodese mit einem Marknagel der neuesten Generation zu untersuchen. Methode: Im Zeitraum von 2005 bis 2007 wurden 28 Patienten mittels winkelstabilem, retrogradem Marknagel mit Kompressionsoption (T2 AAN, Stryker, Duisburg, Germany) versorgt. Neben allgemeinen Angaben zur Zufriedenheit mit dem Ergebnis, dem Alter und Geschlecht wurden der American Orthopedics Foot and Ankle Score (AOFAS) und das Ankle-Scoring-System nach Mazur ermittelt. Weiterhin wurden alle Voroperationen im Zusammenhang mit der Verletzung sowie Vorerkrankungen und Komplikationen dokumentiert und ausgewertet. Ergebnisse: Die Zeit bis zur Nachuntersuchung betrug durchschnittlich 16 Monate (7–27 Monate). Eine knöcherne Fusion wurde bei 27 Patienten erreicht (96 %). Mit dem Ergebnis zufrieden waren 25 Patienten (89 %). Der American Orthopedics Foot and Ankle Score (AOFAS) betrug durchschnittlich 64 Punkte (38–86 Punkte), das Ankle-Scoring-System nach Mazur betrug durchschnittlich 65 Punkte (30–83 Punkte). Es kam bei 7 Patienten (25 %) zu Komplikationen. Darunter 1 Tibiaschaftfraktur bei Implantation, 1 Beinvenenthrombose, 1 Infektion mit Materialbruch der Kalkaneusschraube, 3 Reinfektionen, 1 verzögerte Konsolidierung und 1 Pseudarthrose. Schlussfolgerung: Die analysierten Daten zeigen im Vergleich mit der Literatur eine hohe Rate der knöchernen Konsolidierung und vergleichbare Komplikationsraten. Die Zufriedenheitsrate ist zwar hoch, dennoch bleiben die Patienten entsprechend der Schwere der Erkrankung in ihren Gang- und Standfunktionen weiterhin erheblich eingeschränkt. Nagelarthrodesen bei Infektanamnesen sind kritisch abzuwägen.

Abstract

Aim: The purpose of this study was to evaluate the first clinical experiences with the newest generation retrograde arthrodesis nail. Methods: 28 patients who had tibiotalocalcaneal arthrodesis between 2005 and 2007 using a retrograde compression nail fixation (T2 AAN, Stryker, Duisburg, Germany) were retrospectively reviewed. Complications, functional outcome scores, and patient satisfaction were determined and the radiographs were evaluated for bony healing. Results: The mean time interval until follow-up was 16 months (range: 7–27). All but 1 ankle showed a radiographically healed arthrodesis. 25 patients (89 %) were satisfied with the outcome. The average functional scores at follow-up were 64 (38–86 points) points for the American Orthopedics Foot and Ankle Score (AOFAS) and 65 points for the Mazur Ankle Scoring System (30–83 points). We recorded complications in 7 patients (25 %) including 1 deep infection with breakage of the calcaneus screw, 3 reinfections, 1 deep vein thrombosis, 1 intraoperative fracture of the tibia, 1 delayed union and 1 non-union.

Conclusion: Tibiotalocalcaneal arthrodesis is a salvage procedure. Using a specifically designed retrograde intramedullary nail is a reliable method to achieve fusion. Patient satisfaction is high, but the procedure is demanding and complications are frequent. After infections the indication for nail arthrodesis should be evaluated carefully in each case.

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Dr. med. Kajetan Klos

Klinik für Unfall-, Hand- und Wiederherstellungschirurgie
Friedrich-Schiller-Universität Jena

Erlanger-Allee 101

07747 Jena

Phone: 0 36 41/9-32 28 01

Fax: 0 36 41/9-32 28 02

Email: kajetan.klos@med.uni-jena.de