改良外侧入路距下关节植骨融合术在严重跟骨骨折畸形愈合中的应用

目的:分析改良外侧入路距下关节植骨融合术在严重跟骨骨折畸形愈合中的作用。方法:选取严重跟骨骨折畸形愈合患者25例,均予以改良外侧入路距下关节植骨融合术,术后早期适当给予踝关节功能锻炼,观察手术前后患者距骨跟骨角、距骨第1跖骨角及足部功能改善情况;术后定期随访,记录并发症发生情况。结果:术后12个月,患者距骨跟骨角、距骨第1跖骨角、美国足踝外科协会(AOFAS)评分均较术前明显改善(P<0.01)。术后随访(19.6±5.7)个月,患者切口均一期愈合,未见切口感染、皮缘坏死、跟骨骨质外露等并发症发生。末次随访时,患者足部功能优13例,良9例,差3例,优良率高达88.0%。结论:改良外侧入路距下关节植骨融合术具有入路安全、显露清晰、愈合率高、并发症少等优点,可作为严重跟骨骨折畸形愈合的良好选择。

Application of subtalar joint fusion through modified lateral approach in the treatment of severe malunion after calcaneal fractures

Objective:To analyze the effect of subtalar joint fusion through modified lateral approach in the treatment of severe malunion after calcaneal fractures.Methods:Totally 25 patients with severe malunion after calcaneal fractures were selected,and were all treated with subtalar joint fusion through modified lateral approach.Ankle functional training was given at the early stage after surgery.The improvement of astragalus-calcaneus angle,first metatarsal angle of calcaneus and foot function was observed before and after surgery.The follow-up visits were implemented regularly,and complications were recorded.Results:12 months after surgery,the astragaluscalcaneus angle,first metatarsal angle of calcaneus and scores of American Orthopedic Foot Ankle Society (AOFAS) were all improved when compared with pre-surgery (P ＜0.01).The follow-up time after surgery was (19.6 ± 5.7) months.All incisions had primary healing.No complications,such as incisional infection,flap margin necrosis and calcaneal bone exposure,occurred.At the last follow-up visit,the foot function of 13 patients was excellent,9 good,3 bad,and the excellent and good rate came up to 88.0％.Conclusion:The improved lateral approach arthrodesis has many advantages,such as safe approach,clear exposure,high healing rate and few complications,it can be used as a good choice for severe malunion after calcaneal fractures.