保留距下关节的跟骨V形截骨矫形术治疗陈旧性跟骨骨折

Treatment of old calcaneal fractures with calcaneus V-shape osteotomy for the subtalar joint preservation

目的:探讨保留距下关节的跟骨V形截骨矫形术治疗陈旧性跟骨骨折的临床疗效。方法:回顾性分析2014年3月至2017年11月采用跟骨V形截骨术治疗的陈旧性跟骨骨折18例(18足),其中男13例(13足),女5例(5足);年龄23~48(34.3±4.5)岁;病程2~9(4.5±4.1)个月。Sanders分型:Ⅱ型14例,Ⅲ型4例。观察手术并发症,比较术前及术后12个月跟骨B觟hler角、Gissane角、跟距高度、距骨倾斜角的变化情况;并采用Maryland足部评分评估其临床疗效。结果:14例(14足)患者获得随访,时间13~35(21.2±4.1)个月,4例患者失访。骨折愈合时间10~15(12.4±2.1)周。术后1例患者切口皮肤坏死,未发生骨折不愈合及内固定松动或断裂等并发症。术后12个月距骨倾斜角、B觟hler角、Gissane角及跟距高度[(11.4±5.1)°、(24.7±4.3)°、(124±3.1)°、(46.1±2. 8) mm]较术前[(9.1±2.9)°、(6.8±3.1)°、(93.4±11.7)°、(34.5±5. 3) mm]明显改善。Maryland评分由术前的59.21±7.21提高至术后12个月的86.34±4.14(t=43.1,P<0.05);其中优8例,良4例,可1例,差1例。结论:保留距下关节的跟骨V形截骨矫形术是治疗陈旧性跟骨骨折的有效方法之一,具有保留距下关节,纠正跟骨畸形,改善足部外观,缓解患足疼痛,提高足部功能等优点。

Objective:To observe the clinical effect of calcaneus V-shape osteotomy for the subtalar joint preservation in the treatment of old calcaneal fractures.Methods:A retrospective study was conducted on 18 patients(18 feet)with old calcaneal fractures treated by calcaneus V-shape osteotomy from March 2014 to November 2017.Included 13 males and 5 females,aged from 23 to 48 years old with an average of(34.3±4.5)years and the course of disease was from 2 to 9 months with an average of(4.5±4.1)months.According to the classification of Sanders,14 cases of typeⅡand 4 cases of typeⅢ.The postoperative complications were observed.The changes of Bohler angle,Gissane angle,heel height and the tilt angle of talus were compared between before operation and 12 months after operation.Maryland foot score was used to evaluate the curative effect.Results:Fourteen patients were followed up,4 patients were loss to follow-up.And the follow-up time was 13 to 35 months,with an average of(21.2±4.1)months.The fracture healing time was 10 to 12 weeks with an average of(12.4±2.1)weeks.One patient had skin necrosis of incision after operation,and no complications such as nonunion of fracture and loosening or rupture of internal fixation were found.The tilt angle of talus,Bohler angle,Gissane angle,heel height at 12 months after operation were(11.4±5.1)°,(24.7±4.3)°,(124±3.1)°,(46.1±2.8)mm,respectively,while before operation were(9.1±2.9)°,(6.8±3.1)°,(93.4±11.7)°,(34.5±5.3)mm,there were significant difference between before and after operation.Maryland score was significantly increased from 59.21±7.21 preoperatively to 86.34±4.14 postoperatively 12 months(t=43.1,P<0.05),and 8 cases got excellent results,4 good,1 fair,1 poor.Conclusion:Calcaneus V-shape osteotomy for subtalar joint preservation is one of the effective methods in the treatment of old calcaneal fractures,which has the advantages of preserving subtalar joint,correcting calcaneal deformity,inproving foot appearance,alleviating foot pain and raising foot function.