后侧距下关节融合术治疗跟骨骨折后遗症

目的：介绍自体植骨后侧距下关节融合术治疗跟骨骨折后遗症的方法及临床效果。方法：2001年1月-2004年1月，对33例37足跟骨骨折严重后遗症患者采用自体植骨后侧距下关节融合术的方法进行治疗，男30例34足，女3例3足；年龄22-47岁，平均32．7岁；单侧跟骨骨折29例29足，双侧跟骨骨折4例8足。选择跟骨外后上侧改良“L”形切口行自体植骨后侧距下关节融合术，其中29例33足取全板髂骨块和外膨的跟骨外侧壁植骨，2例2足取全板髂骨块植骨，2例2足取外膨的跟骨外侧壁植骨。全部切除外膨的跟骨外侧壁。结果：全部病例均获得随访，随访时间10-20个月，平均14个月。随访中采用keer跟骨骨折百分评分系统：平均92．1分，较术前平均升高54．7分。X线片示Bohler角、Gissane角、跟骨轴长、跟骨宽度、距骨倾斜角基本恢复正常。结论：自体植骨后侧距下关节融合术是治疗跟骨骨折后遗症的一种有效方法，可矫正跟骨骨折后遗症，恢复后足外形及功能。

Posterior Subtalar Arthrodesis for Severe Sequela of Calcaneal Fractures

Objective： To introduce bone autografi and subtalar arthrodesis for severe sequela caused by calcaneal fractures, and to evaluate its clinical effects. Methods： From January 2001 to January 2004, 33 cases （30 males and 3 females with an average age of 32.7 years） of sequela caused by calcaneal fractures were treated with bone autograft and posterior subtalar arthrodesis. Among them, unilateral calcaneus was involved in 29 cases, and bilateral calcaneus was affected in 4 cases. The modified extended L-shaped lateral approach was used, autograft of iliac crest and the bulging lateral wall of calcaneus were harvested and implanted in 29 cases （33 feet）, autografi of iliac crest was harvested and implanted in 2 cases （2 feet）, the bulging lateral wall of calcaneus was harvested and implanted in 2 cases （2 feet）. All the bulging lateral wall of calcaneus were excised. Results： All patients were followed up for a mean period of 14 months （range, 10-20 months）. According to Keer foot score system, it was mean 92.1, 54.7 highier than pre-op. Plain radiography showed that Bohler angle, Gissane angle, Longitudinal length, Calcaneal width, Talus inclining angle were restored to nearly normal. Conclusion： The bone autograft combined with subtalar arthrodesis is an effective operation for severe sequela caused by calcaneal fractures, it can correct sequela of calcaneal fractures, and recover the shape and function of metaleg satisfactorily.