距下关节融合与跟骨丘部矫形术治疗严重跟骨骨折畸形愈合

目的观察距下关节融合与跟骨丘部矫形术联合治疗严重跟骨骨折畸形愈合的临床疗效,探讨其手术适应证及优、缺点。方法1994年12月~2006年1月,对84例(96足)跟骨骨折畸形愈合的患者行距下关节融合与跟骨丘部矫形术,采取跟骨外侧手术入路,取自体松质骨植骨距下关节融合及内固定。其中男51例62足,女33例34足;年龄21~58岁,平均38.5岁。单侧72例,双侧12例。损伤原因:高处坠落伤57例,交通事故伤22例,其他5例。损伤至手术时间6~31个月,平均9.5个月。结果术后患者均获随访1~132个月。根据美国足踝外科协会足与踝关节评分标准,优31足,良53足,差12足,优良率87.5%。术后X线片示Bo。hler角、Gissane角、跟骨丘部高度及跟骨宽度与术前比较,差异均有统计学意义(P<0.01)。结论自体松质骨植骨距下关节融合与跟骨丘部矫形术是治疗跟骨骨折畸形愈合的一种有效方法,能恢复后足外形及功能,明显降低跟骨骨折步行疼痛后遗症的发生率。

SUBTALAR ARTHRODESIS AND CALCANEAL THALAMUS RECONSTRUCTION FOR MALUNION OF CALCANEAL FRACTURES

OBJECTIVE: To evaluate the clinical results of subtalar arthrodesis and calcaneal thalamus reconstruction for malunion of calcaneal fractures and to discuss the indications and its advantages of the management. METHODS: From December 1994 to January 2006, 84 cases (96 feet) of malunion of calcaneal fractures were treated with subtalar arthrodesis and calcaneal thalamus reconstruction. The L-shaped approach lateral to calcaneus was used. The bone autograft was harvested from iliac crest. Fifty-one cases were male and 33 cases were female, aging from 21 to 58 years (mean 38.5 years). One side was in volved in 72 cases and two sides in 12 cases. The injury was caused by falling from height in 57 cases, by traffic accident in 22 cases and other in 5 cases. It was 6-31 months from injury to operation (mean 9.5 months). RESULTS: Among the patients, all cases were followed up 1 to 132 months. The total excellent and good rate was 87.5% including excellent in 31 feet, good in 53 feet and fair in 12 feet,according to Hindfoot scores system (American Orthopaedics Foot and Ankle Society). The Bohler's and Gissane's angles, the height of calcaneal thalamus and width of calcaneus were significant different from those of preoperation (P < 0.01). CONCLUSION: The treatment by bone autograft combined with subtalar arthrodesis and calcaneal thalamus reconstruction is an effective operation for malunion of calcaneal fractures, with advantages of correcting deformity, restoring the function of hindfoot and relieving the pain of walking.