跟骨丘部重建加距下关节融合术治疗SandersⅢ型跟骨关节内陈旧性骨折

Reconstruction of calcaneal thalamus and subtalar arthrodesis to treat old antiquated intra articular calcaneal fractures of Sanders type Ⅲ

目的:观察跟骨丘部重建与距下关节融合术联合治疗严重的跟骨关节内陈旧性骨折的临床疗效,总结其手术适应证及注意要点。方法:2006年3月至2011年7月,采用跟骨丘部重建与距下关节融合术联合治疗SandersⅢ型跟骨关节内陈旧性骨折患者26例,男15例,女11例;年龄27～45岁,平均34岁;病程7～24个月,平均18个月。术前X线片及CT示Gissane角增大,B觟hler角减小,跟骨增宽向两侧膨出。术后复查时行影像学检查并对跟骨宽度、丘部高度、B觟hler角及Gissane角进行测量,并与术前比较。根据AOFAS踝后足评分标准对手术前后患足功能进行评分,比较改善程度。结果:24例患者获完整随访,随访时间5～26个月,平均19个月。X线片证实所有患者融合成功,未发生严重感染,其中1例患者术后出现皮缘坏死,行带腓肠神经营养血管岛状皮瓣转位修复术后皮瓣存活,伤口愈合良好。患者AOFAS踝后足评分由术前的(41.00±8.22)分提高到术后的(79.04±7.46)分;结果优3例,良15例,中6例。术后跟骨宽度、丘部高度、B觟hler角及Gissane角较术前有明显改善(P<0.01)。结论:重建跟骨丘部的距下关节融合术是治疗陈旧性跟骨骨折的一种有效方法,可矫正跟骨畸形、恢复足部外形并改善后足功能。

Objective ：To observe the outcome of treatment for serious old intra-articular calcaneal fracture by reconstruction of calcaneal thalamus and subtalar arthrodesis and to summarize the operative indications and its attention points. Methods：From March 2006 to July 2011,26 patients with Sanders type Ⅲ old intra-articular calcaneal fracture were treated includ- ing 15 males and 11 females with an average age of 34 years old ranging from 27 to 45 years old. The clinical courses ranged from 7 to 24 months with an average of 18 months. Before the operation,X-ray and CT showed that Gissane angle increased while Bohler angle decreased,and calcaneus broadened,bulging on both sides. After the operations,all patients tested by imaging examination, and the width of calcaneus,the height of calcaneal thalamus, the Bohler angle and Gissane angle were measured to compare with the preoperative data. Besides ,for identification of improvement of the operation,the functions of patient＇s feet after the operation were graded according to AOFAS Ankle-Hindfoot Scale to compare with preoperative data. Results：Among them, 24 patients were followed-up from 5 to 26 months with an average of 19 months. X-rays confirmed that all cases healed successfully. There were no serious infection, and only one skin necrosis case. Sural neurocutaneous island flap was used to repair the skin with success. According to AOFAS Ankle-Hindfoot Scale, the total score increased from preoperative （41.00±8.22） to postoperative （79.04±7.46）. There were 3 cases of excellent result, 15 cases of good result, and 6 cases of fair result. Postoperative width of calcaneus, the height of thalamus, Bohler angle and Gissane angle were better than that of preoperative data, and had statistical significance between two groups. Conclusion： Subtalar arthrodesis with the reconstruction of calcaneal thalamus is an effective way to treat old intra-articular calcaneal fractures. It can correct the calcaneal deformity, restore the shape of foot and improve the function of hind foot.