摘要
目的探讨经改良的外侧入路行距下关节植骨融合治疗严重跟骨骨折畸形愈合的方法及疗效。方法2010年1月至2011年12月,收治获得完整随访的跟骨骨折畸形愈合StephenⅡ、Ⅲ型患者31例,男22例,女9例;年龄23~68岁,平均45.2岁,左足14例,右足17例。其中21例为后足内翻畸形,10例为外翻畸形。31例患者均采用改良的外侧入路,术中行跟骨外侧壁骨赘切除及腓骨肌腱松解,撑开距下关节并刮除软骨关节面,植入三层皮质的自体髂骨;再用2~3枚空心螺钉固定距下关节。比较手术前、后距骨第一跖骨角及距骨跟骨角、美国足踝外科协会踝与后足评分及视觉模拟评分。术后定期门诊随访,观察距下关节植骨融合及内植物稳定情况。结果手术时间70~110 min,平均(85±15)min。随访时间为15~28个月,平均(19±6)个月。所有患者无切口愈合问题,无内植物松动、切出。其中29例患足疼痛消失或明显减轻,30例跟骨内外翻畸形明显改善,未发生融合失败。步态正常,无需借助辅助工具。距骨第一跖骨角自术前(16.8±2.3)°改善至术后(5.6±1.2)°,距骨跟骨角自术前(15.8±2.1)°改善至术后(26.1±2.3)°,美国足踝外科协会踝与后足评分自术前(33.2±6.2)分升至术后(84.7±5.6)分,疼痛评分自术前(8.1±0.8)分降至术后(2.2±1.1)分,以上指标手术前、后比较差异均有统计学意义(P〈0.05)。末次随访时根据美国矫形足踝协会踝与后足评分标准进行功能评估,优16例,良8例,中4例,优良率为85.7%。结论采用改良外侧入路距下关节植骨融合治疗严重跟骨骨折畸形愈合,入路安全简便,显露清楚,可直接显露距下关节面,又几乎不受手术时机的限制,伤口甲级愈合率高。同时并发症少,疗效满意,可逐渐取代"L"形手术切口。因此改良外侧入路是治疗严重跟骨骨折畸形愈合的较好选择。
Objective To evaluate the efficacy of the subtalar joint fusion through the modified lateral approach for the treatment of severe caleaneal. Methods A total of 31 patients (22 males and 9 females) with complete follow - up of ealcane- al Ⅱ , Ⅲ type Malunion Stephen were enrolled in the present study from January 2 0 1 0 to December 2 0 1 1 . Median age was 45.2 years with a range of 23 to 68 years. At time of the study ,21 patients had the hind foot varus deformity, and 10 had valgus deformity. 31 cases of patients were treated with a modified lateral approach, intraoperative lateral wall of the calcaneus resec- tion of osteophytes and peroneal tendon release, distraction the subtalar joint joint and scaling surface of cartilage, implanting tricortical iliac crest autograft ;then 2 to 3 canuulated screw were fixed in the subtalar joint. Regular outpatient follow-up were done with talus and first metatarsal angle, talus calcaneal angle. American Association of Foot and Ankle Surgery (AOFAS) ankle and hindfoot score and visual analogue scale (VAS) were used. Moreover, the subtalar joint fusion and stability of the implant were observed after operation. Results The operation time was 70 - 110 (85 ± 15 ) min. Follow-up time was 15 - 28 ( 19 ± 6 ) months. All the incision healed well, and there was no plant loosening and cutting out. Foot pain of 29 cases signifi- cantly reduced. The Calcaneal valgus deformity and the calcaneal varus deformity of 30 cases significantly improved. There was no fusion failure. The talus first metatarsal angle improved from ( 16.8 ± 2.3 )° pre-operatively to (5.6 ± 1.2 )° post-opera- tively, the talus calcaneus angle from (15.8± 2. 1 )° pre-operatively to (26. 1 ± 2.3 )° post-operatively, AOFAS ankle and hindfoot angle improved from (33.2±6.2) ° pre-operatively to (84.7 ± 5.6 ) post-operatively. Pain scores decreased from ( 8.1 ± 0.8 ) pre-operatively to ( 2.2± 1.1 ) post-operatively. Statistically significant difference was found ( P 〈 0.05 ). The last follow-up conducted according to the American Orthopaedic Foot and Ankle Society cases were excellent in 16 cases ,good in 8 cases , and mild in 4 cases. The excellent rate was 85.7%. Conclusion The methods of the subtalar joint fusion through the modified lateral approach for the treatment of severe calcaneal is safe and easy and has the advantage of clearly and thoroughly exposure the subtalar joint. The grade of wound healing rate is high. The subtalar joint fusion can acquire satisfactory clinical outcomes with fewer complications. It can gradually replaces L-shaped incision. Therefore modified lateral approach is the better choice for the treatment of severe calcaneal Malunion.
出处
《实用骨科杂志》
2016年第2期126-129,188,共5页
Journal of Practical Orthopaedics
关键词
外侧入路
跟骨骨折
畸形
关节融合术
lateral approach
calcaneal fractures
deformity
arthrodesis