三关节融合术治疗跟骨骨折远期并发症的疗效评价

EVALUATION OF THE EFFECT OF TRIPLE ARTHRODESIS ON TREATING COMPLICATIONS OF CALCANEUS FRACTURES

目的 评价采用三关节融合术治疗跟骨骨折远期并发症的临床疗效。方法1990年～2001年，采用距下、距舟和跟骰三关节融合术治疗12例跟骨骨折并发症患者，均行Ollier足外侧切口，其中2例行腓骨肌腱松解术，1例行胫神经减压和移位术。本组男7例，女5例，年龄29～64岁。于骨折后5～22个月，平均18个月，出现疼痛、畸形等并发症。术前后足功能评分、腓骨远端至跟骨中心距离、Bohler角、患足与正常足距骨前倾角之差和跟骨高度分别为40．00±5．22分、0．41±0、03cm、12．00±3．40°、17．00±3．32°和4．12±0．35cm。结果 术后获随访3～13年，平均7年。术后后足功能评分、腓骨远端至跟骨中心距离、Bohler角、患足与正常足距骨前倾角之差和跟骨高度分别为75．00±6．46分、0．73±0．02cm、31．00±5、6l°、9．00±3．15°和6．75±0．62cm，各指标与术前比较差异均有统计学意义（P〈0．05）。结论 对跟骨骨折并发后足疼痛和畸形，进行病因评估及采用适当的手术方式是极其重要的；恢复后跟高度和跟骨的解剖关系是手术成功的关键。

Objective To evaluate the effect of triple arthrodesis on treating complications of ealeaneus fractures. Methods From 1990 to 2001, 12 patients with the complications of calcaneus fractures underwent the triple arthrodesis （subtalar, talaronavieular and caleaneoeuboid joints）. Oilier incision was applied to all patients. Peroneal tenolysis was required in 2 patients and a decompression and transposition of tibial nerve in 1 patient. Of the 12 patients, 7 were males and 5 were females. Their ages ranged from 29 to 64 years. Complications, like pain and deformity, occurred 5 to 22 months after the operation（18 months on average）. Preoperative score, fibulocalcaneal distance, Bohler angle, difference of talar declination angle and height of hind foot were 40.00±5.22, 0.41±0.03 cm, 12.00±3.40°, 17.00± 3.32° and 4. 12± 0. 35 cm respectively. Results All patients were followed up from 3 to 13 years with an average of 7 years. Postoperative score, tibulocaleaneal distance, Bohler angle, difference of talar declination angle and height of hind foot were 75.00±6.46,0.73±0.02 em, 31.00±5.61°,9.00±3.15° and 6.75±0.62 em respectively. There were significant differences in these indexes（P〈0.05）. Conclusion To evaluate the complications of ealcaneus fractures and to adopt proper operative procedures are necessary. To restore the height of hind foot and the anatomical relationship between hind foot and calcaneus is the key factor to success.