跟骨丘部及后距下关节重建治疗跟骨骨折畸形

目的探讨保留距下关节跟骨丘部及后距下关节重建治疗严重陈旧性跟骨骨折畸形愈合的方法及适应证。方法跟骨丘部及后距下关节重建治疗严重陈旧性跟骨骨折畸形愈合8例，均为男性，年龄在21～34岁，平均31．5岁。单侧7例，双侧1例。损伤时间1～7个月，平均4．6个月。行重建丘部及后距下关节保留距下关节自体植骨的方法进行治疗，切除跟骨外膨的外侧壁，取跟骨外侧壁植骨7例，取髂骨植骨1例。结果8例9足获得随访，随访时间8～24个月，平均11个月。按美国足踝外科协会Maryland足部评分系统评价术后功能：优4足，良4足，可1足，差0足，优良率为88．9％。所有患者术后足外形恢复良好。术后切口感染裂开1例、螺钉断裂1例，无跟骨内翻等并发症。骨折愈合时间10．5～16．2周，平均12．6周。术后X线片显示跟骨丘部高度、宽度、BoNer角，以及Gissane角基本恢复正常。结论重建跟骨丘部及距下关节自体植骨术具有矫正跟骨畸形，恢复后足外形及功能明显的优点，是治疗严重陈旧性跟骨骨折畸形愈合的有效方法。

Calcaneal Cumulus and Subtalar Joint Reconstruction for Malunion of Calcaneal Fracture

Objective To investigate the calcaneal cumulus and subtalar joint reconstruction for treatment of malunion of calcaneal fracture,and to investigate the indications.MethodsFrom 2003 to 2005,8 patients with intra-articular calcaneal fracture with malunion(9 feet)were treated with calcaneal cumulus and subtalar joint reconstruction and bone autografts to reserve subtalar joint and correct deformity.ResultsThe follow-up period ranged from 8 to 24 months(average 11 months).According to American Orthopaedics Foot and Ankle Society(AOFAS)Maryland score's standard,4 feet were excellent,4 good,1 fair,and none were poor.The excellent and good rate was 88.9%.Plain radiographs showed that the height of calcaneal cumulus,calcaneal width,Bohler angle and Gissane angle were almost normal.ConclusionThe calcaneal cumulus and subtalar joint reconstruction is a clinically safe,reasonable,and effective technique to treat malunion of calcaneal fracture with advantages of correcting deformity,restoring the function and the outer aspect of hindfoot.