跟骨骨折畸形愈合的手术治疗  

Surgical treatment of calcaneal fracture malunion

作　　者：庄泽[1] 何波 刘远高 吴亮 石益 吴佳君 王昆[1] 史德海[1] Zhuang Ze;He Bo;Liu Yuangao;Wu Liang;Shi Yi;Wu Jiajun;Wang Kun;Shi Dehai(Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院关节创伤外科,510630

出　　处：《中华创伤骨科杂志》2019年第10期906-909,共4页Chinese Journal of Orthopaedic Trauma

基　　金：广东省中医药科学技术研究项目(20181061).

摘　　要：目的探讨跟骨骨折畸形愈合的手术治疗效果。方法回顾性分析2011年1月至2017年9月中山大学附属第三医院关节创伤外科收治的19例(19足)伤后6周至8月跟骨骨折畸形愈合患者资料。患者男16例,女3例;年龄22~57岁,平均36.2岁。畸形按Stephens-Sanders分型:Ⅰ型10例,Ⅱ型6例,Ⅲ型3例。Stephens Ⅰ型患者采用保留距下关节的跟骨外侧壁骨突切除、松解腓骨长短肌腱进行治疗;Ⅱ型患者采用外侧骨突切除、腓骨肌腱减压及距下关节融合术;Ⅲ型患者采用内外侧双入路,外侧骨突切除、腓骨肌腱减压、内侧斜行截骨外侧撑开矫正内翻畸形并距下关节融合术。术后采用Maryland功能评分评估手术疗效。结果所有患者术后均未发生切口、内固定物感染、螺钉断裂及距跟关节不融合等并发症。19例患者中17例获得随访,时间18~26个月(平均20.5个月)。末次随访时足部功能Maryland评分为(90.2±7.3)分,较术前(38.6±5.5)分改善,差异有统计学意义(t=53.370,P< 0.001)。结论Stephens-Sanders Ⅰ型患者采用保留距下关节的跟骨截骨矫形术,Ⅱ、Ⅲ型采取距下关节融合术均可取得满意的疗效。Objective To evaluate the surgical treatment of calcaneal fracture malunion. Methods A retrospective analysis was conducted of the 19 patients with calcaneal fracture malunion (19 feet) who had been treated from January 2011 to September 2017 at Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital, Sun Yat-Sen University. They were 16 males and 3 females with the average age of 36.2 years (from 22 to 57 years). According to Stephens-Sanders classification, the malunion was defined as type Ⅰ in 10 cases, as type Ⅱ in 6 and as type Ⅲ in 3. The patients with malunion of type Ⅰ were treated by lateral wall osteotomy and decompression of long and short peroneus muscles to preserve the subtalar joint, those with malunion of type Ⅱ by lateral wall osteotomy and decompression of long and short peroneus muscles followed by subtalar joint fusion, and those with malunion of type Ⅲ by lateral wall osteotomy, decompression of long and short peroneus muscles, medial oblique osteotomy for correction of varus deformity and subtalar joint fusion via both the medial and lateral approaches. The Maryland functional scores were used to assess the postoperative surgical efficacy. Results No such complications happened as incision or implant infection, screw breakage or joint non-fusion. Of the 19 patients, 17 were followed up for 18 to 26 months (mean, 20.5 months). The Maryland scores at the final follow-ups were 90.2±7.3, significantly higher than the preoperative values (38.6±5.5)(t=53.370, P<0.001). Conclusions In the surgical treatment of calcaneal fracture malunion, satisfactory clinical efficacy can be achieved by lateral wall osteotomy and preservation of the subtalar joint for patients with maunion of Stephens-Sanders type Ⅰ, and by subtalar fusion for those with maunion of Stephens-Sanders types Ⅱ-Ⅲ.

关 键 词：跟骨 骨折 骨折愈合 距下关节 融合 

分 类 号：R687[医药卫生—骨科学]