双平面截骨术治疗Stephens-SandersⅡ型跟骨骨折畸形愈合的疗效分析  

Biplane osteotomy to treat malunion of Stephens-Sanders typeⅡcalcaneal fracture

作　　者：王震宇 杨方程 程梅 郑果 倪乾坤 李远强 苟小力 唐康来 陶旭 Wang Zhenyu;Yang Fangcheng;Cheng Mei;Zheng Guo;Ni Qiankun;Li Yuanqiang;Gou Xiaoli;Tang Kanglai;Tao Xu(Sports Medicine Center,The First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Hematologic Tumor Center,Chongqing University Cancer Hospital,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院运动医学中心,重庆400038 [2]重庆大学附属肿瘤医院血液肿瘤中心,重庆400038

出　　处：《中华创伤骨科杂志》2023年第10期833-839,共7页Chinese Journal of Orthopaedic Trauma

基　　金：重庆市科卫联合医学科研项目(2023MSXM121);运动损伤修复与重建研究创新群体(cstc2020jcyj-cxttX0004)。

摘　　要：目的探讨双平面截骨术治疗Stephens-SandersⅡ型跟骨骨折畸形愈合的疗效。方法回顾性分析2019年1月至2022年1月陆军军医大学第一附属医院运动医学中心接受双平面截骨术治疗的31例Stephens-SandersⅡ型跟骨骨折畸形愈合患者资料。其中男21例,女10例;年龄(41.4±13.9)岁;受伤至手术时间(12.8±8.9)个月。比较患者术前、术后6个月、末次随访时患者的功能性和影像学评分,功能性评分包括疼痛视觉模拟评分(VAS)、美国足踝外科协会(AOFAS)的踝-后足评分、PROMIS评分患者报告结果测量信息系统评分中的疼痛影响评分(PI)和物理功能评分(PF);影像学评分包括足负重侧位X线片上测量的Gissane角、Böhler角、跟骨后倾角、跟骨长度、足绝对高度、轴位跟骨宽度。结果本组患者手术时间为(106.6±29.9)min。31例均获随访,时间为(18.4±5.8)个月。本组患者术后6个月、末次随访时的VAS评分[3(2,3)、2(1,3)分]、AOFAS的踝-后足评分[83(76,87)、85(83,87)分]、PI评分[(57±9)、(48±6)分]、PF评分[53(39,61)、56(54,66)分]、Gissane角(109.6°±14.1°、109.3°±14.9°)、Böhler角(26.5°±11.6°、26.9°±11.8°)、跟骨后倾角[19.1°(14.5°,23.9°)、19.9°(14.5°,23.9°)]、足绝对高度[(76.5±9.6)、(76.0±9.9)mm]、轴位跟骨宽度[(38.5±4.1)、(38.3±4.1)mm]均较术前[5(4,6)分、62(56,67)分、(62±6)分、47(38,51)分、126.8°±13.1°、11.8°±10.9°、13.8°(8.2°,18.7°)、(71.0±9.1)mm、(42.8±5.5)mm]显著改善,差异均有统计学意义(P<0.05)。而术前、术后6个月、末次随访时跟骨长度比较差异均无统计学意义(P>0.05)。结论双平面截骨术治疗Stephens-SandersⅡ型跟骨骨折畸形愈合矫形能力强,临床疗效好。Objective To evaluate the clinical efficacy of biplane osteotomy in the treatment of malunion of Stephens-Sanders typeⅡcalcaneal fracture.Methods A retrospective study was conducted to analyze the clinical data of 31 patients who had been treated by biplane osteotomy at Sports Medicine Center,The First Affiliated Hospital of Army Medical University for malunion of Stephens-Sanders typeⅡcalcaneal fracture from January 2019 to January 2022.There were 21 males and 10 females,with an age of(41.4±13.9)years and a duration from injury to diagnosis of(12.8±8.9)months.Functional and image scores were compared before surgery,6 months after surgery,and at the last follow-up.Functional scores included the visual analogue scale(VAS)score,the American Orthopedic Foot and Ankle Society(AOFAS)score,and the pain interference(PI)and physical function(PF)indices in the Patient-Reported Outcomes Measurement Information System(PROMIS).Image scores included the Gissane angle,Böhler's angle,calcaneal pitch angle,length of the calcaneus,absolute foot height,and axial calcaneal width as measured on X-rays.Results The operation time was(106.6±29.9)minutes for this cohort.All the 31 patients were followed up for(18.4±5.8)months.At 6 months after surgery and the last follow-up,the VAS scores[3(2,3),2(1,3)],AOFAS scores[83(76,87),85(83,87)],PI scores[(57±9),(48±6)],PF scores[53(39,61),56(54,66)],Gissane angles(109.6°±14.1°,109.3°±14.9°),Böhler angles(26.5°±11.6°,26.9°±11.8°),calcaneal pitch angles[19.1°(14.5°,23.9°),19.9°(14.5°,23.9°)],absolute foot heights[(76.5±9.6)mm,(76.0±9.9)mm],and axial calcaneal widths[(38.5±4.1)mm,(38.3±4.1)mm]were all significantly improved compared to the preoperative values[5(4,6),62(56,67),(62±6),47(38,51),126.8°±13.1°,11.8°±10.9°,13.8°(8.2°,18.7°),(71.0±9.1)mm,(42.8±5.5)mm](all P<0.05).However,there was no statistically significant difference in the length of the calcaneus among pre-surgery,6 months after surgery,and the last follow-up(P>0.05).Conclusion Biplane os

关 键 词：跟骨 骨折 距下关节 截骨术 矫形外科手术 

分 类 号：R687.3[医药卫生—骨科学]