伴有跟骨塌陷的晚期距下关节炎的手术治疗

摘要：目的 探讨应用经皮空心螺钉取自体髂骨植骨融合内固定技术治疗伴有跟骨塌陷的晚期距下关节炎的临床效果。方法 对2009年3月～2012年3月，我科应用经皮空心螺钉、取自体髂骨、植骨融合内固定术治疗伴有跟骨塌陷的晚期距下关节炎患者12例（13足），对比手术前后的Bohler角（跟骨结节关节角）、Gissane角，统计术后跟距关节融合率，并根据美国足踝关节协会功能评分（AOFAS）对患者足踝功能及术后效果进行评价。结果 术后经过6～29（13.1±1）个月随访，12例（13足）跟距关节均得到骨性融合，术后美国足踝医师协会足与踝关节功能评分（AOFAS）功能评分60~100分，平均85.5分，优8例，良3例，可1例，优良率91.7%，所有患者均能正常行走，足弓基本恢复正常，Bohler角由术前的平均5.47°±0.37°恢复至术后平均19.89°±1.28°，Gissane角由术前的平均154.60°±4.35°恢复至术后平均120.28°±2.48°。结论 对于伴有跟骨塌陷的晚期距下关节炎行跟骨结节上方经皮空心螺钉、取自体髂骨、植骨内固定术进行治疗，可重建距下关节稳定性，恢复Bohler角及Gissane角，本方法具有创伤较小，可达到良好的解剖复位，融合率高，稳定性好等优点。

Surgical treatment of subtalar arthritis with depression fracture of the calcaneus at later period

【Abstract】 Objective：To approach the treatment of percutaneous hollow screw internal fixation for subtalar arthritis with depression fracture of the calcaneus at later period.Method：From March 2009 to March 2012，12 cases（13 feet） were performed percutaneous hollow screw internal fixation.The Bohier angle,the Gissane angle,post-operation fusion rate were compared and conduct the AOFAS evaluation. Result: The follow-up period ranged from 6 months to 29 months（13.1±1months），bony fusion was found in all cases（13 foots）.Function results were assessed according to AOFAS score,the average score was 85.5.There were 8 cases in excellent results，3 cases in good，1 case in fair. ll the patients were healed and their arches became normal．The average data of Bolder angle were 19.89°±1.28°after operation while 5.47°±0.37°before operation． The average data of Gissane angle were 120.28°±2.48°after operation while 154.60°±4.35°before operation.Conclusion：Percutaneous hollow screw fixation is an effective method for the subtalar arthritis with depression fracture of the calcaneus at later period，it can resume the Bolder angle and Gissane angle and alleviate the clinical symptom efficiently.