经后外侧入路距下关节撑开植骨融合治疗陈旧性跟骨骨折畸形愈合

目的评价经后外侧人路行距下关节撑开植骨融合术治疗陈旧性跟骨骨折畸形愈合的临床疗效。方法回顾性研究自2009-03-2012—10收洽的采用后外侧人路距下关节撑开植骨融合术治疗且获得完整随访的27例陈旧性跟骨骨折畸形愈合患者。定期随访观察术后切口愈合、骨折愈合及内固定情况，比较手术前后距骨跟骨角、距骨第1跖骨角、美国足踝外科协会（AOFAS）踝与后足评分。结果27例术后获平均20（12～36）个月随访，切口均一期愈合，无皮缘坏死、切口感染及内固定物、跟骨骨质外露发生。术后4～6个月X线片显示27例融合处均骨性愈合。距骨跟骨角由术前平均（15．8±3．0）°改善至术后平均（24．8±1．9）°，距骨第1跖骨角由术前平均（16．9±3.2）°改善至术后平均（5．6±1．9）°，AOFAS评分由术前平均（33．9±7．9）分提高至术后平均（84．9±7．5）分，差异均有统计学意义（P〈0．05）。结论跟骨后外侧人路可清楚显露距下关节，能在直视下对距下关节面进行彻底清理，撑开植骨矫正跟骨内、外翻畸形，恢复足弓，矫正或减轻跟骨骨折畸形愈合的主要病理改变，有效地改善症状，减少切口并发症，临床疗效满意。

Treatment of malunited calcaneus fracture with subtalar distraction bone block fusion through posterolateral approach

Objective To evaluate the clinical results of subtalar distraction bone block fusion through posterolateral approach for the treatment of malunited ealeaneus fracture. Methods From March 2009 to October 2012, 27 cases of malunited chronic ealeaneus fracture undergoing treatment and complete fallow-up were reviewed. Subtalar distraction bone block fusion through posteR）lateral approach was performed in all eases in this series. The healing of fracture and internal fixation, wound healing after operation were observed. Regular follow-up was done with the talar-ealeaneal angle and talar-lst metatarsal angle measurement and AOFAS （American Orthopaedic Foot ＆ Ankle Society） and ankle-hindfoot scale. Results All the 27 patients were followed up for 20 months （range,12 to 36 months）. All the incision healed well, no skin necrosis, infection of incision and fixation of ealeaneus exposure occurred. After 4-6 months X-ray showed that 27 eases were bone healed fusion at the fusion sit. The average AOFAS and ankle-hindfoot scale improved from （33.9±7.9） pre-operatively to （84.9±7.5） post- operatively, the talar-ealcaneal angle improved from （15.8±3.0）° pre-operatively to （24.8±1.9）° post-operatively, the talar-lst metatarsal angle also improved from （16.9±3.2）° pre-operatively to （5.6±1.9）° post-operatively, and the difference was significant （P 〈0.05）. Conclusion The subtalar distraction bone block fusion may acquire satisfactory clinical outcomes,with restoring the arch of the foot, effective improvement major symptoms and correcting the main deformity induced by the malunion of caleaneous fracture. As the posterolateral approach can be used to treat the malunited calcaneus fracture with the exposure clearly and thoroughly clean the subtalar joint, it orovides the direct vision for the subtalar distraction bone block fusion