跟骨V型截骨融合术治疗严重创伤性距下关节炎  

V-shaped Calcaneal Osteotomy and Fusion for Severe Traumatic Subtalar Arthritis

作　　者：张松 张永红 孙宁[2] 武勇[2] ZHANG Song;ZHANG Yong-hong;SUN Ning(Guizhou orthopedic hospital,Guiyang,Guizhou 550000)

机构地区：[1]贵州省骨科医院足踝外科,贵州贵阳550000 [2]北京积水潭医院足踝外科

出　　处：《中国伤残医学》2021年第16期4-7,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:比较研究2种手术方法治疗严重创伤性距下关节炎的临床疗效。方法:研究的对象:采用回顾、随机原则选取2018年1月-2020年6月诊断治疗的42例严重创伤性距下关节炎患者,分为距下关节撑开融合组和跟骨V型截骨融合组,各21例,比较研究2组临床治疗疗效。结果:距下关节撑开融合术组:合并跟腱挛缩5例,行跟腱三点式微创松解。合并跟骨内翻9例,行跟骨楔形截骨(Dwyer截骨)。出现伤口皮肤部分坏死1例,经VSD负压吸引、植皮后治愈;跟骨V型截骨融合组:合并跟腱挛缩6例,行跟腱三点式微创松解。合并跟骨内翻11例,行跟骨Dwyer截骨;2组均无空心螺钉松动、断裂;比较2组术前影像学Bohler角、Pitch角、跟骨宽度、跟骨高度及跟骨后足力线,统计学差异无意义(P>0.05);比较2组手术时间(min)、术中出血(ml)、骨愈合时间(month)、末次随访AOFAS踝-后足评分,统计学差异有意义(P<0.05),跟骨V型截骨融合组优于距下关节撑开融合组;比较2组末次随访的Bohler角、Pitch角、跟骨宽度跟骨高度及跟骨后足力线,统计学差异有意义(P<0.05),跟骨V型截骨融合组优于距下关节撑开融合组。结论:跟骨V型截骨融合术治疗严重创伤性距下关节炎的临床治疗效果优于距下关节撑开融合术。Objective:To compare the clinical efficacy of two surgical methods in the treatment of severe traumatic subtalar arthritis.Methods:Forty-two patients with severe traumatic subtalar arthritis diagnosed and treated from January 2018 to June 2020 were randomly selected and divided into subtalar joint extension and fusion group and calcaneus V-shaped osteotomy and fusion group,with 21 cases in each group.The clinical efficacy of the two groups was compared and studied.Results:In the subtalar joint distraction and fusion group,5 patients with Achilles tendon contracture were treated with three-point minimally invasive release of Achilles tendon.Nine patients with calcaneus varus were treated with Dwyer osteotomy.Partial necrosis of wound skin occurred in 1 case,which was cured after VSD suction and skin grafting.V-shaped calcaneal osteotomy and fusion group:6 patients with Achilles tendon contracture were treated with three-point minimally invasive tendon release.11 patients with calcaneus varus were treated with Dwyer osteotomy.There was no loosening or fracture of hollow screws in the two groups.Preoperative imaging of Bohler Angle,Pitch Angle,calcaneal width,calcaneal height and calcaneal posterior foot force line between the two groups showed no statistically significant differences(P>0.05).The operative time(min),intraoperative bleeding(ml),bone healing time(month)and AOFAS ankle-hindfoot score at the last follow-up were compared between the two groups,and the differences were statistically significant(P<0.05).The V-type calcaneal osteotomy and fusion group was better than the subtalar joint dispersal and fusion group.The Bohler Angle,Pitch Angle,calcaneal width,calcaneal height and calcaneal posterior foot force line were compared between the two groups at the last follow-up,and the differences were statistically significant(P<0.05).The V-shaped calcaneal osteotomy and fusion group was superior to the subtalar joint extension and fusion group.Conclusion:V-type calcaneal osteotomy and fusion is more effective tha

关 键 词：畸形愈合 跟骨截骨矫形:距下关节炎 

分 类 号：R683.42[医药卫生—骨科学]