跟骨关节内骨折合并腓骨肌腱滑脱的手术治疗  

Surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation

作　　者：尚林[1] 王翔宇[1] 王爱国[1] 徐俊峰[1] 贾光辉[1] 李琦[1] 王亚磊[1] Shang Lin;Wang Xiangyu;Wang Aiguo;Xu Junfeng;Jia Guanghui;Li Qi;Wang Yalei(Department of Foot and Ankle Surgery, Orthopaedics Hospital of Zhengzhou, Zhengzhou 450052, China)

机构地区：[1]郑州市骨科医院足踝外科,450052

出　　处：《中华创伤骨科杂志》2019年第7期614-617,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨跟骨关节内骨折合并腓骨肌腱滑脱的治疗方法及疗效。方法回顾性分析郑州市骨科医院足踝外科自2014年2月至2017年6月手术治疗的15例(15足)跟骨关节内骨折合并腓骨肌腱滑脱的患者资料,其中男9例(9足),女6例(6足);左足8例,右足7例;年龄20~55岁,平均42.5岁。跟骨骨折复位后采用钛板、螺钉固定,通过腓骨肌上支持带在外踝止点建立骨道,将滑脱的腓骨肌腱复位后将腓骨肌上支持带缝合固定于外踝,骨膜加强缝合,术后用石膏托固定踝关节于跖屈内翻位6周。术后采用美国足踝外科协会(AOFAS)踝-后足评分、疼痛视觉模拟评分(VAS)和并发症观察疗效。结果15例患者术后获12~36个月(平均20.5个月)随访。所有患者跟骨骨折均完全愈合,腓骨肌腱未发生再次滑脱。AOFAS踝-后足评分80~95分(平均87.4分),VAS评分0~5分(平均1.5分)。其中1例发生切口延迟愈合,经常规换药,最终获得一期愈合。随访期间1例患者出现腓肠神经皮支损伤症状,经口服营养神经药物6个月后症状消失。1例患者发生距下关节炎,伴持续疼痛,保守治疗无效后给予距下关节融合术,疼痛消失。余患者未见其他并发症发生。结论对于跟骨关节内骨折合并腓骨肌腱滑脱在治疗跟骨骨折的同时修复滑脱的腓骨肌腱,可以取得满意的疗效。Objective To evaluate the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation. Methods From February 2014 to June 2017, 15 patients (15 feet) with intra-articular calcaneal fracture associated with peroneal tendon dislocation were treated at Department of Foot and Ankle Surgery, Orthopaedics Hospital of Zhengzhou. There were 9 males (9 feet) and 6 females (6 feet), and 8 left feet and 7 right feet. The patients were aged from 20 to 55 years (average, 42.5 years). After reduction of calcaneal fractures, titanium plates and screws were used for fixation. The bone canal was established on the lateral malleolus, and the torn superior peroneal retinaculum was fixed to the lateral malleolus by suture after reduction of the peroneal tendon. The ankle joint was immobilized with a plaster brace in the metatarsal flexion for 6 weeks. The postoperative outcomes were evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS);complications were recorded. Results All the 15 patients were followed up for 12 to 36 months (average, 20.5 months). All the calcaneal fractures fully healed and no re-dislocation of the peroneal tendon occurred. The AOFAS hindfoot-ankle scores ranged from 80 to 95 points, averaging of 87.4 points;the VAS scores ranged from 0 to 5 points, averaging 1.5 points. Delayed wound healing was observed in one case but primary healing was achieved eventually with regular dressing change. Another case presented with symptoms of injury to the cutaneous branch of the sural nerve which disappeared after oral administration of neurotrophic drugs for 6 months. Another case suffered from subtalar arthritis accompanied by persistent pain which disappeared after subtalar arthrodesis. No other complications were observed in the other patients. Conclusion In the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation, the peroneal tendon dislocation should be treated simultaneously w

关 键 词：跟骨 骨折 骨折固定术 内 腓骨肌腱 脱位 

分 类 号：R687.3[医药卫生—骨科学]