距下关节融合术治疗跟骨骨折畸形愈合

目的探讨跟骨骨折畸形愈合治疗的方法。方法对21名男性患者共21例跟骨骨折畸形愈合进行腓骨肌腱松解,跟骨外侧壁骨赘切除及单一距下关节融合或三关节融合手术治疗。结果随访8～47个月,平均随访16个月,对治疗结果进行评定。跟骨畸形有明显改善,患足疼痛消失或明显减轻,患足步态明显改善,患者术后均较满意。根据美国足踝创伤协会评分,自术前平均36．7分（18～56分）升至术后平均71．3分（44～85分）。疼痛评分术前8．2分（7～10分）至术后2．0分（0～4分）。结论跟骨骨折畸形愈合多数表现为跟骨增宽和由此引起的跟腓撞击与腓骨肌腱卡压导致的疼痛,以及不同程度的距下关节炎及后足内外翻畸形。CT扫描可以清楚地了解跟骨畸形及各相关关节创伤性关节炎的情况,以利分型和指导治疗。采用单一的距下关节融合术即可以达到比较满意的疗效。

Treatment of calcaneal malunion fracture with isolated subtalar arthrodesis

OBJECTIVE: To evaluate the effect of treatment of calcaneal malunion fracture with isolated subtalar arthrodesis. METHODS: Twenty-one patients with calcaneal malunion fracture, with 21 diseases feet, all males, underwent tenolysis of peroneal tendon, lateral exostectomy, and isolated arthrodesis of subtalar joint and were followed up for 16 months (8-47 months). American Orthopedic Foot and Ankle Society and pain score systems were used to evaluate the changes of symptoms. X-ray films were taken to observe the changes of the bones. RESULTS: The calcaneal deformity was greatly improved in all the patients and the symptom of pain disappeared or was alleviated. The mean post-operational AOFAS score was 71.3 (44-85) points, higher than that before the operation [36.7 (18-56) points]. The pain mean post-operational score was 2.0 (0-4) points, much lower than that before the operation [8.2 (7-10) points]. CONCLUSION: Surgical treatment including tenolysis of peroneal tendon, lateral exostectomy, and isolated arthrodesis of subtalar joint is effective on calcaneal malunion fracture.