Illizarov牵拉与截骨融合分期治疗跟骨骨折畸形愈合

Staged Ilizarov distraction and osteotomy fusion for severe malunion of calcaneal fractures

[目的]介绍Illizarov牵拉与截骨融合分期治疗跟骨骨折畸形愈合的手术技术和初步临床结果。[方法] 2014年10月—2019年2月,收治18例严重陈旧性跟骨骨折患者。所有患者均采用一期跟骨体部截骨,Ilizarov外固定架固定,术后逐步牵拉,延长跟骨和矫正畸形,二期行跟骨外侧壁多余骨质切除,距下关节融合术的方法进行治疗。[结果]所有患者均顺利手术。随访时间(22.17±3.64)个月。末次随访时AOFAS踝与后足评分46~92分,平均(81.17±10.29)分;临床结果评定为优2例,良13例,一般2例,差1例,优良率83.33%。所有患者足外形恢复良好,能穿普通鞋。影像方面,术后所有患者跟骨高度均得到了恢复,纠正了跟骨内翻。B?hler角由术前的平均(-3.11±7.26)°,恢复到平均(29.94±3.54)°(P<0.05);Gissane角由术前的平均(92.17±12.73),恢复到平均(121.33±8.75)°(P<0.05)。[结论] Ilizarov外固定架分期治疗严重陈旧性跟骨骨折畸形愈合是一种可行且安全有效的方法,可明显恢复跟骨的形态,术后功能良好。

[Objective] To introduce the surgical technique and preliminary clinical results of staged Illizarov distraction and osteotomy fusion for severe malunion of calcaneal fractures. [Methods] From October 2014 to February 2019, 18 patients were surgically treated for severe malunion of calcaneal fractures. At the first stage, all patients received calcaneal body osteotomy and external fixation with Ilizarov frame, and then calcaneal lengthening and correction of the deformity by gradual distraction with the frame. At the second-stage,all of them underwent resection of residual redundancy of the calcaneus lateral wall and subtalar arthrodesis. [Results] All patients underwent the operations smoothly. The follow-up period lasted for(22.17±3.64) months. At the last follow-up, the AOFAS ankle and hindfoot score was of 46~92 points, with an average of(81.17±10.29) points;correspondingly, the clinical results were marked as excellent in 2 cases, good in 13 cases, fair in 2 cases, and poor in 1 case, with excellent and good rate of 83.33%. All the patients’ feet recovered well to fit ordinary shoes. In terms of imaging evaluation, the height of the calcaneus in all patients was restored after the operation, and the calcaneal inversion was corrected. The B?hler angle was restored from(-3.11±7.26)° preoperatively to(29.94±3.54)° at the latest follow-up(P<0.05);while the Gissane angle was restored from(92.17±12.73)° to(121.33±8.75)°(P<0.05). [Conclusion] The staged Ilizarov distraction and osteotomy fusion is a feasible, effective and safe method for the treatment of serious calcaneal fracture malunion, which can obviously restore the shape of the calcaneus and good postoperative function.