距下关节融合并跟骨关节外截骨矫形术治疗陈旧性跟骨关节内骨折

Subtalar arthrodesis and calcaneal outside articular osteotomy in treatment of old intra-articular calcaneal fractures

目的观察距下关节融合并跟骨关节外截骨矫形术治疗陈旧性跟骨关节内骨折的临床疗效。方法回顾性分析自2015-05—2018-12诊治的19例(21足)陈旧性跟骨关节内骨折,采用改良跟骨外侧L形切口跟骨外侧壁切除、跟骨关节外截骨矫形、距下关节融合术治疗。测量并比较术前与末次随访时跟骨Bohler角、跟骨Pitch角、跟骨宽度、跟骨高度、跟骨后足力线。末次随访时评估踝与后足功能AOFAS评分。结果19例均获得随访,随访时间8~19(12.7±2.9)个月。切口均一期愈合,末次随访时患足均骨性愈合,无空心钉松动、断裂发生。末次随访时跟骨Bohler角、跟骨Pitch角、跟骨宽度、跟骨高度及跟骨后足力线较术前明显改善,差异有统计学意义(P<0.05)。末次随访时踝与后足功能AOFAS评分为(85.0±4.9)分,较术前(39.9±7.1)分明显提高,差异有统计学意义(P<0.05)。结论距下关节融合并跟骨关节外截骨矫形术是治疗陈旧性跟骨关节内骨折的一种有效方法,可以较好地恢复跟骨的高度、宽度、后足力线、Bohler角、Pitch角,有效地消除距下关节炎引起的疼痛及骨折畸形愈合带来的病理性改变。

Objective To evaluate the clinical effect of subtalar arthrodesis and calcaneal outside articular osteotomy in the treatment of old intra-articular calcaneal fractures.Methods A retrospective analysis of 19 cases(21 feet)of old intraarticular calcaneal fractures diagnosed and treated from May 2015 to December 2018 was conducted.They were treated with modified L-shaped incision of the lateral calcaneus,subtalar arthrodesis and calcaneal outside articular osteotomy.The Bohler angle of calcaneus,Pitch angle of calcaneus,width of calcaneus,height of calcaneus and hindfoot alignment before operation and at the last follow-up were measured and compared.AOFAS scale was evaluated at the last follow-up.Results Nineteen patients were followed up for 8 to 19 months,with an average of(12.7±2.9)months.All the incision healed well and the bone healed,no loosening or fracture of cannulated screw occurred.At the last follow-up,Bohler angle of calcaneus,Pitch angle of calcaneus,width of calcaneus,height of calcaneus and hindfoot alignment were improved than the preoperative assessment,and the difference was statistically significant(P<0.05).And the AOFAS scale improved from(39.9±7.1)points pre-operatively to(85.0±4.9)points post-operatively,and the difference was statistically significant(P<0.05).Conclusion Subtalar arthrodesis and calcaneal outside articular osteotomy are an effective method for the treatment of old intra-articular calcaneal fractures.It can recover the height,width hind foot alignment,Bohler angle and Pitch angle of calcaneus,and effectively eliminate the pain caused by subtalar arthritis and pathological changes caused by fracture malunion.