Ilizarov外固定支架治疗Stephen III型陈旧性跟骨骨折畸形愈合

Ilizarov external fixators for maluninon of obsolete calcaneal fracture of Stephen Type III

目的评价llizarov外固定支架治疗Stephenm型陈旧性跟骨骨折畸形愈合的疗效。方法自2006年7月至2009年2月，采用一期距下关节融合、跟骨截骨并llizarov外固定支架牵伸二期纠正畸形治疗Stephen9I型陈旧性跟骨骨折畸形愈合患者25例，男19例，女6例；年龄19～49岁，平均32岁；左足15例，右足10例。既往累计手术次数1—5次，平均2次。术后应用美国足踝外科协会（AOFAS）踝与后足评分系统进行评价。结果所有患者术后获18．3个月（6～36个月）随访。治疗结束时所有患者内、外翻畸形均得到完全或大部分矫正，可以用足底行走负重。距下关节均一期融合，跟骨高度、宽度、长度、Bohler角及Gissane角均得到明显恢复。81％的患者取得内、外翻畸形的解剖复位或近解剖复位。AOFAS评分平均为79．4分，优2例，良18例，一般4例，差1例，优良率为80．0％。所有关节融合的部位最后均获得骨连接，无一例患者发生内、外翻畸形需再次手术。结论对于StephenIII型陈旧性跟骨骨折畸形愈合患者，采用一期距下关节融合、跟骨截骨并Ilizarov外固定支架缓慢牵伸纠正畸形可获得良好疗效。

Objective To evaluate the clinical effects of Ilizarov external fixator for maluninou of obsolete calcaneal fracture of Stephen Type III. Methods From July 2006 to February 2009, 25 patients suffering from maluninon of obsolete calcaneal fracture of Stephen Type III were treated with subtalar arthredesis and ealcaneal osteotomy followed by fixation with llizarov external fixator. They were 19 men and 6 women, aged from 19 to 49 years. Fifteen left feet and 10 right feet were involved. The patients underwent previous operations from one to 5 times, averaging twice. The postoperative functions were evaluated by American Orthopaedic Foot ＆ Ankle Society （AOFAS） scoring system. Results The average follow-up was 18.3 months （from 6 to 36 months）. 81% of the patients obtained anatomic or nearly anatomic reduction of the varus and valgus. The average AOFAS score was 79.4, with 2 excellent, 18 good, 4 fair and one poor cases. Conclusion Subtalar arthrodesis and caleaneal osteotomy followed by fixation with llizarov external fixator is effective for treating maluninon of obsolete calcaneal fracture of Stephen Type ill.