外侧四刀截骨矫正跟骨骨折畸形愈合  

Lateral four-cut osteotomy for correction of malunion of calcaneus fractures

作　　者：张宇飞 李文祥 王爱国[2] 李兴华[2] 马富强[2] 史炎鑫 白玉[2] ZHANG Yu-fei;LI Wen-xiang;WANG Ai-guo;LI Xing-hua;MA Fu-qiang;SHI Yan-xin;BAI Yu(Henan University of Traditional Chinese Medicine,Zhengzhou 450002,China;Orthopaedic Hospital of Zhengzhou City,Zhengzhou 450052,China)

机构地区：[1]河南中医药大学,河南郑州450002 [2]郑州市骨科医院,河南郑州450052

出　　处：《中国矫形外科杂志》2022年第8期741-744,共4页Orthopedic Journal of China

摘　　要：[目的]介绍外侧四刀截骨矫正跟骨骨折畸形愈合的手术技术和初步临床效果.[方法]2016年1月-2019年10月应用外侧四刀截骨矫正跟骨骨折畸形愈合19例.患者取健侧卧位,行外踝尖下横切口显露跟骨,根据术前评估,选择性做四刀截骨,第1刀外侧壁截骨,第2刀后关节面周围截骨,第3刀载距突外侧截骨,第4刀后结节垂直或弧形截骨.截骨后恢复关节面平整、矫正畸形,骨质缺损区植骨,跟骨锁定钢板固定截骨.必要时行跟腱延长术.[结果]19例患者均顺利完成手术,无严重并发症.随访时间9~30个月.与术前相比,末次随访时,VAS评分、AOFAS踝-后足部评分,影像测量跟骨高度、宽度、B?hler角及Gissane角均显著改善(P<0.05).[结论]采用外侧四刀截骨术矫正跟骨骨折畸形愈合,可有效纠正跟骨高度、宽度、长度及B?hler、Gissane角,恢复后足生物力线.[Objective]To introduce the surgical technique and preliminary clinical outcomes of the lateral four-cut osteotomy for correction of malunion of calcaneus fractures.[Methods]From January 2016 to October 2019,19 patients received the lateral four-cut osteotomy for correction of malunion secondary to calcaneus fractures.The patients were placed on the healthy side,and a transvers incision was made under the tip of lateral malleolus to expose the calcaneus.According to the preoperative plan,four-cut osteotomy on calcaneus was conducted,including the first cut on the lateral wall of calcaneus,the second cut on the periarticular bone,the third cut outside to sustentaculum tali and the fourth cut on posterior tuberosity vertically or in curvature.After that,the articular surface was restored with correction of deformity and bone autografting for bone defect.Finally,plate fixation was performed,whereas Achilles tendon lengthening was added if necessary.[Results]All the 19 patients had operation completed successfully without serious complications.The follow-up period was lasted for 9~30 months.Compared with those preoperatively,the VAS and AFOAS scores,as well as the height,width,Bohler angle and the Gissane angle measured on radiographs significantly improved at the latest follow up(P<0.05).[Conclusion]This lateral four-cut osteotomy does effectively restore the height,width,length,the Bohler and Gissane angles of the calcaneus to resume the biomechanical alignment of the foot for malunion of calcaneus fractures.

关 键 词：跟骨骨折 畸形愈合 外侧横切口 四刀截骨术 

分 类 号：R683.42[医药卫生—骨科学]