内侧壁复位不良对跟骨骨折术后内翻畸形的影响及内翻畸形的其他影响因素分析

Effect of inadequate reduction of medial wall on the postoperative varus deformity following calcaneal fracture surgery and other influencing factors of varus deformity

目的探讨跟骨骨折内侧壁复位不良对跟骨骨折术后内翻畸形的影响，及内翻畸形的其他影响因素。方法回顾性分析2005年10月至2015年9月收治的60例涉及内侧壁的跟骨骨折患者临床资料，男51例，女9例；年龄18-55岁，平均38．4岁；骨折按照Sanders分型：Ⅱ型24例，Ⅲ型30例，Ⅳ型6例。测量术前、术后内、外侧壁完整度，术后内、外侧壁恢复程序，术前、术后跟骨高度及宽度，术前、术后Bohler角、跟骨内翻角，并进行统计学分析。结果术后内侧壁高度恢复较外侧壁高度恢复对术后内翻角正常率的影响大，差异有统计学意义（P〈0．05），术后内侧壁完整度越高，术后跟骨内翻角正常率越高。术后跟骨内翻角的正常率随着Sanders分型的加重逐渐减少，差异有统计学意义（P=0．001）。术后高度及宽度恢复程度越好、术前及术后内侧壁完整度越高术后内翻角在正常范围内的几率越高，差异有统计学意义（P〈0．05）。结论术前内侧壁越完整，术后内侧壁解剖复位并内固定牢固，术后内翻角正常率越高；术后内、外侧壁高度均恢复时内翻角正常率最高，内侧壁复位不良、外侧壁复位良好时术后内翻角正常率最低。Sanders分型、术后跟骨高度、宽度恢复程度也对术后内翻角有影响。

Objective To explore the effect of inadequate reduction of the medial wall on the postoperative varus deformity following calcaneal fracture surgery and other influencing factors of varus deformity. Methods A retrospective analysis was conducted of the 60 patients with calcaneal fracture in-volving the medial wall （60 feet） who had been treated from October 2005 to September 2015. They were 51 men and 9 women, 18 to 55 years of age （average, 38.4 years）. According to the Sanders classification, 24 patients belonged to type Ⅱ, 30 to type Ⅲ, and 6 to type IV. We measured the integrity of the pre- and post-operative medial walls, the height and width of the pre- and post-operative calcanei, the pre- and post-operative Bohler angles and the pre- and post-operative calcaneal varus angles for statistical analysis. Results The effect of postoperative height reduction of the medial wall on the postoperative correction of varus angle was significantly larger than that of the lateral wall （ P 〈 0.05）. The higher the integrity of the postoperative medial wall, the larger the correction of the postoperative varus angle. The normal rate of postoperative calcaneal varus angle significantly decreased with the increased Sanders classification severity （ P = 0. 001 ）. The postoperative reduction of the height and width of the calcaneus and the integrity of the pre- and post-operative medial wails were significantly positively correlated to the normal rate of postoperative calcaneal varus angle （ P 〈 0. 05）. Conclusions The medial wall has a large influence on the postoperative ealcaneal varus angle. The higher integrity of the preoperative medial wall, and the more adequate reduction and fixation of the postoperative medial wall as well, the higher rate of postoperative normal ealeaneal varus angle. The postoperative reduction of the caleaneal height also affects the varus angle. When the heights of the medial and lateral walls are recovered, the normal rate of varus angle is the highest; when reduction of the medial wall is in- adequate but reduction of the lateral wall is fine, the normal rate of varus angle is the lowest.