距下关节撑开植骨融合治疗跟骨骨折畸形愈合

目的 报告并评价撑开植骨距下关节融合治疗跟骨骨折畸形的效果.方法 2004年9月至2008年1月共收治32例跟骨骨折畸形愈合患者.按照Stephens CT分型Ⅱ型畸形28例,Ⅲ型4例;术前X线及CT检查,跟骨距骨角均值18.1°,美国足踝外科协会(AOFAS)评分均值36.3.手术采用撑开植骨距下关节融合的方法治疗,术后定期随访,测量距骨跟骨角,行AOFAS评分.结果 32例患者均获随访,随访时间24-65个月,平均34个月.除1例术后创口皮缘浅表坏死经换药愈合外,切口均一期愈合,无感染发生.术后3个月融合处均获骨性愈合.末次随访时,距骨跟骨角均值22.9°,功能评分平均77.5分.与术前比较差异具有统计学意义(P<0.05).结论 撑开植骨距下关节融合及外侧骨突切除能纠正或减轻跟骨骨折畸形愈合的主要病理改变,并有效地改善症状,是治疗跟骨骨折畸形愈合较为实用的方法.

Teatment of malunited calcaneus fracture with subtalar distraction bone block fusion

Objective To report and evaluate the results of subtalar distraction bone block fusion in the treatment of malunited calcaneus fracture. Methods From September 2004 to January 2008, 32 cases of malunited calcaneas fracture were treated, among which 28 cases were classified type Ⅱ and 4 cases type Ⅲ by Stephens-Sander's classification. Preoperative X-ray and CT examination demonstrated a talocalcancus angle of 18.1°±2.3°, and an AOFAS score of 36.3 ±4. 1. Subtalar distraction bone block fusion was performed in all cases in this series. Regular follow-up was done with talocalcaneus angle measurement and AOFAS scoring. Results All the 32 patients had been followed-up of 34 months, ranging from 24 to 65 months, only to reveal a primary wound healing without infection in all but one, in which superficial skin necrosis occurred postoperatively and healed after dressing-changes. Bone healing at the fusion site was seen 3 months after operation in all cases. At the final follow-up, the talocalcaneus angle was 22. 9°± 1.9°and the AOFAS score 77. 5 + 4. 1, both demonstrating a significant difference ( P < 0. 05 ), when compared with those before operation. Conclusion Subtalar distraction bone block fusion, together with the lateral wall decompression, can correct the main deformity and reduce major symptoms induced by the malunion of calcaneous fractures, being a convenient and practical option for the treatment of malunited calcansus fracture.