tailieunhanh - Viêm khớp mắt cá chân

Bệnh nhân bị viêm khớp mắt cá chân và biến dạng có thể bị đau nặng và tàn tật chức năng. Những bệnh nhân không đáp ứng với phương thức điều trị nonoperative là ứng cử viên cho arthrodesis mắt cá chân, thay đổi bệnh lý trong khu vực subtalar có thể được loại trừ. | Ankle Arthrodesis Indications and Techniques Nicholas A. Abidi MD Gary S. Gruen MD and Stephen F. Conti MD Abstract Patients with ankle arthritis and deformity can experience severe pain and functional disability. Those patients who do not respond to nonoperative treatment modalities are candidates for ankle arthrodesis provided pathologic changes in the subtalar region can be ruled out. Several techniques are available for performing the procedure the most successful combine an open approach with compression and internal fixation. The foot must be positioned with regard to overall limb alignment and in the optimal position for function. A nonunion rate as high as 40 has been reported. Osteonecrosis of the talus and smoking are known risk factors for nonunion. When good surgical technique is used in carefully selected patients ankle arthrodesis can be a reliable procedure for the relief of functionally disabling ankle arthritis deformity and pain. J Am Acad Orthop Surg 2000 8 200-209 The ankle joint consists of a highly constrained articulation of the talus with the tibial plafond and the distal fibula. With weight bearing congruity between the sulcus of the talus and the tibial plafond provides stability in the sagittal plane in a normal ankle joint. Torn or detached ligaments around the ankle joint however allow abnormal coronal-plane instability with weight bearing. The deep deltoid ligament carries the primary blood supply to the medial aspect of the body of the talus from the posterior tibial artery. Therefore at least on a theoretical basis an effort should be made to preserve the deltoid ligament during surgical procedures on or about the ankle joint. Damage to the ankle joint from trauma or disease can result in progressive loss of the tibiotalar articular cartilage surface with resulting inflammation synovitis osteophyte formation progressive loss of anklejoint motion weight-bearing pain and functional disability. A variety of techniques for ankle .