截骨矫形、保留距下关节治疗陈旧跟骨骨折

Osteotomy and Subtalar Joint Preservation for Old Calcaneal Fractures

目的探讨采用截骨矫形、保留距下关节、锁定解剖钢板内固定治疗陈旧性跟骨骨折畸形愈合的临床疗效。方法回顾性分析2016年6月~2018年12月我科收治的21例伤后5~16周陈旧跟骨关节面压缩骨折患者的临床资料,均行跟骨外侧壁切除、跟骨截骨寻找关节面、矫形复位关节面、锁定解剖接骨板内固定治疗。术后采用Maryland足部评分系统评价术后患肢功能。结果本组21例均手术经过顺利,手术时间平均65(50~80)min,术中出血量平均70(50~100)ml。所有骨折均复位,直视下见关节面恢复平整,Bohler角平均33°(22°~35°)。21例均获随访,随访时间12~24个月,平均(18±6)个月,骨折愈合时间为术后10~12周。末次随访患足功能按Maryland足部评分:优13足,良7足,可1足,优良率为95.24%。1例患者出现跟骨伤口转角处皮肤坏死,经换药后伤口一期愈合。结论采用截骨矫形、保留距下关节、锁定钢板内固定治疗陈旧跟骨关节面压缩骨折可重建跟骨关节面,保留距下关节活动度,恢复距下关节匹配,疗效确切,值得临床推广应用。

To investigate the clinical effect of osteotomy,subtalar joint preservation and internal fixation with locking anatomical plate for treatment of old calcaneus fracture within 5 to 16 weeks after injury.Methods The clinical data of 21 cases with old compression fracture of calcaneus articular surface(during 5 to 16 weeks after injury)admitted from June 2016 to December 2018 were analyzed retrospectively.All cases were performed the surgery of external calcaneus wall resection,calcaneus osteotomy for articular surface,orthopedic reduction of articular surface and internal fixation of locking anatomical plate.The function of the involved limb was evaluated by the Maryland foot scoring system.Results The surgery was succeed in all 21 cases.The average operation time was 65 minutes(ranged,50~80 minutes),and the mean intraoperative blood loss was 70 ml(ranged,50~100 ml).All fractures achieved ideal reduction,and Bohler angle was restored to 33°(ranged,22°~35°).All cases were followed up for 12 to 24 months with an average of(18±6)months.All cases were followed up for 12 to 24 months with an average of 18±6 months,and achieved fracture union during 10 to 12 weeks after the surgery.According to Maryland score,the foot function was revealed that excellent in 13 foots,good in 7 foots and fair in 1 case.The fineness rate was 95.23%.Skin necrosis of the corner of calcaneus wound was found in one case,and cure by change dressing.Conclusion The treatment of osteotomy,subtalar joint preservation and internal fixation with locking anatomical plate can achieve an ideal effect for old compression fracture of calcaneus articular surface by effective reconstruction of the calcaneal articular surface,preservation of the subtalar joint active range and restoration of the subtalar joint matching,and which is worthy of clinical generalization.