Ankle Arthrodesis

Arthrodesis is a procedure that causes the bones of the joints to be tough. When the ankle joint is strong, there is no pain and obvious deformity, and various labors can still be walked and completed, and the operation has no effect on the appearance. The function lost after the fusion can be compensated by the joint part of the sacral joint, so the postoperative effect is more satisfactory. Easy to accept for patients. Ankle arthrodesis is an effective means of terminating lesions, relieving pain, correcting deformities and providing joint stability. Although there are certain drawbacks, such as non-healing and malunion healing, it is still considered as a standard for severely damaged ankle joints. treatment method. Treatment of diseases: ankle joint tuberculosis scoliosis septic arthritis Indication 1. Due to joint trauma, inflammation, degeneration, etc., the joint surface is disproportionate, causing severe joint dysfunction, or stubborn joint pain, affecting work and life, non-surgical treatment is invalid, and other surgery is not suitable. To maintain joint mobility, joint fusion should be performed. For example, severe arthritis caused by intra-articular fractures of the lower extremities, and there are a large number of scars in the surrounding soft tissue after septic arthritis, and it is not suitable for surgery such as arthroplasty. 2. Adult all-tubular tuberculosis, joint surface destruction, it is estimated that the joint function can not be preserved, joint fusion can be performed at the same time as the lesion is removed; and there are deformities, which can correct the deformity at the same time. 3. Muscle spasm caused by neuropathy or injury, causing severe instability of the joint, affecting the whole limb function, and simple tendon metastasis is not enough to maintain joint stability and restore sufficient effective function. Fixing local joint can improve limb function. Perform joint fusion. For example, after the anterior horn polio of the spinal cord, the upper limbs can not be lifted. If the shoulder joint is fixed in the functional position, the function of the upper limb can be improved by sliding the shoulder between the shoulders. 4. Congenital or acquired spinal deformity (such as hemivertebra, scoliosis, lumbar spondylolisthesis, etc.), in order to prevent the development of deformity, early laminectomy can be performed, or after deformity correction. Contraindications In addition to the general contraindications for elective surgery, the following conditions should also be contraindicated: 1. Patients with osteoarthritis adjacent to the joint should not be used for arthrodesis. If the hip joint is fused, its activity can be compensated by the normal lumbar spine and knee joint to meet the needs of work and life activities. If the lower lumbar or knee joint is already stiff, hip fusion will cause great difficulty to the patient. 2. Among the same joints of the limbs, one side has a strong straight, and the contralateral side should not be subjected to arthrodesis. If the hip joints are fused on both sides, it will be very difficult to get up, lie, walk and sit. 3. Children's articular cartilage is rich, joint fusion is not easy to cause bone fusion, but also easy to damage the epiphysis, affecting growth and development; at the same time, children in the limb development stage and muscle sustained action, the fusion joint can be deformed again. Therefore, children under the age of 12 should not undergo arthrodesis. Preoperative preparation 1. Arthrodesis may actually include a series of operations such as lesion removal, joint fusion, bone transplantation, and correction of deformity, so it is a complicated operation. Therefore, the surgical plan should be determined according to these surgical requirements, comprehensive consideration, try to get a surgery, a cut to solve the problem, in order to achieve the best results at the least cost. 2. Loss of activity after joint fusion can cause the patient's ideological concerns, and should be dispelled before surgery: the fusion of a joint that affects the function of the limb will improve the function of the entire limb. 3. The joints of the shoulders, hips and other large joints have more bleeding during the operation, and there is a possibility of shock. A certain amount of blood should be reserved before surgery. When the elbow and knee joints are operated, the inflatable tourniquet is used to keep the field clear for the operation. 4. Inflammatory joint disease (such as tuberculosis, suppurative) should be applied preoperative antibiotics or anti-tuberculosis drugs to control the infection or prevent the recurrence of the resting lesion. 5. If the joint has soft tissue contracture, the deformity will not be easily corrected during the operation, and the joint will be difficult to reset. It is difficult to maintain stability even if it is barely repositioned; if it is strongly corrected during surgery, it will cause damage to nerves, blood vessels, etc. Postoperative muscle spasm, and even cause complications such as dislocation. Therefore, traction should be performed before surgery to overcome contracture as much as possible; and design the steps to relieve contracture during surgery. Surgical procedure 1. Position: It is placed in a reclining position on the healthy side, at a 45° angle to the operating table, and is padded with a sandbag. 2. Incision and exposure: The incision is made along the posterior and inferior border of the lower part of the humerus. The lower end starts from the anterior border of the humerus, and the upper end is 8 cm above the lateral malleolus. The iliac tendon is opened and the humerus is removed under the periosteum (the lower end of the iliac crest and the Achilles tendon) The ligament must be preserved), and the ankle joint can be revealed by cutting the humerus down at 6 to 7 cm. 3. Excision of cartilage surface: The periosteum of the tibia is cut longitudinally at the interosseous membrane, and the lateral side of the lower end of the tibia is removed under the periosteum to prepare for bone grafting. If there is a lesion, the lesion should be removed. In the front, the extensor tendon, the dorsal motion, the vein, and the nerve should be removed to protect the lesion, the joint capsule should be removed, and then the foot should be inverted to dislocate the ankle joint and continue to remove the joint cavity. Lesion. After rinsing in the wound, the cartilage surface of the ankle joint is removed. 4. Embolization of the humerus: the chiseled or rough surface of the humerus, the resection distance, the cartilage surface corresponding to the tibia, a shallow groove corresponding to the lower part of the rib of the tibia, and a part of the small piece of pine from the lower part. The bone is prepared to fill the residual gap of the fusion surface. Then, the special person keeps the ankle joint in the functional position (flexion 90°, neutral position, pay attention to prevent internal, valgus or adduction, abduction). The humerus was repositioned and inserted into the humeral bone groove. After the ankle joint was pressed up and down and the ankle joint surface was in close contact, the humerus was fixed on the tibia and talus with 2 to 3 screws. Filled with cancellous bone in joint space and bone graft gap. Loosen the tourniquet and suture it layer by layer after thorough hemostasis. complication Toe blood supply.