Objectives: 

To report the outcomes of staged tibiotalocalcaneal (TTC) arthrodesis for critical-sized bone defects involving the ankle joints.

Design: 

Retrospective review of case series.

Setting: 

Two academic Level 1 trauma centers.

Patients/Participants: 

The study included 20 patients with critical-sized (≥2 cm) segmental bone defects around the ankle joints.

Intervention: 

Staged TTC arthrodesis was performed with induced membrane technique and retrograde intramedullary nail.

Main Outcome Measurements: 

We investigated the radiological evaluation, including modified radiographic union scale for tibia fractures score, time to union, and leg length discrepancy, and functional outcomes using foot and ankle outcome score and American Orthopaedic Foot and Ankle Society ankle–hindfoot score.

Results: 

The average bone defect was 6.4 cm (range: 2.4–12.3). Two of the 20 (10%) patients developed recurrence of infection. Fifteen patients (75%) achieved primary healing. Three patients (15%) were treated with repeated bone grafting and additional plating. The average time to union and leg length discrepancy were 10 months (range: 5–21) and 9 mm (range: 0–31), respectively. The mean foot and ankle outcome score and American Orthopaedic Foot and Ankle Society ankle–hindfoot score were 63 (range: 52–71) and 74 (range: 64–81), respectively.

Conclusions: 

Staged TTC arthrodesis with induced membrane technique and intramedullary nail can be an effective treatment method for critical-sized bone defects involving the ankle joints.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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涉及踝关节的严重骨缺损的治疗：采用诱导膜技术和髓内钉的分期胫跟关节融合术

目标： 

报告分期胫距（TTC）关节融合术治疗涉及踝关节的严重骨缺损的结果。

设计： 

案例系列的回顾性审查。

环境： 

两个学术一级创伤中心。

患者/参与者： 

该研究包括 20 名踝关节周围严重大小（≥2 厘米）节段性骨缺损的患者。

干涉： 

采用诱导膜技术和逆行髓内钉进行分期 TTC 关节融合术。

主要成果测量： 

我们调查了放射学评估，包括胫骨骨折评分的改良放射影像学愈合量表、愈合时间和腿长差异，以及使用足踝结果评分和美国骨科足踝协会踝-后足评分的功能结果。

结果： 

平均骨缺损为 6.4 厘米（范围：2.4-12.3）。20 名 (10%) 患者中有 2 名出现感染复发。15 名患者 (75%) 实现了初步愈合。3 名患者 (15%) 接受了重复骨移植和附加钢板治疗。愈合时间和腿长差异的平均时间分别为 10 个月（范围：5-21）和 9 毫米（范围：0-31）。平均足踝结果评分和美国骨科足踝协会踝-后足评分分别为 63（范围：52-71）和 74（范围：64-81）。

结论： 

采用诱导膜技术和髓内钉进行的分期 TTC 关节融合术是治疗踝关节严重骨缺损的有效方法。

证据等级： 

治疗级别 IV。有关证据级别的完整描述，请参见作者说明。