滑行截骨联合距下关节融合术治疗严重跟骨骨折畸形愈合  

Sliding osteotomy combined with subtalar arthrodesis for severe calcaneal malunion

作　　者：田浩栋 刘亮[1] 胡东[1] 鹿军 Tian Haodong;Liu Liang;Hu Dong;Lu Jun(Department of Foot and Ankle Surgery,Honghui Hospital Affiliated to Xi'an Jiaotong University,Xi'an Shaanxi,710054,China)

机构地区：[1]西安交通大学附属红会医院足踝外科,陕西西安710054

出　　处：《生物骨科材料与临床研究》2024年第4期36-39,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的 探究滑行截骨联合距下关节融合术治疗严重跟骨骨折畸形愈合的疗效。方法 从2018年1月至2022年1月,对西安交通大学附属红会医院收治的28例严重的跟骨骨折畸形愈合患者进行滑行截骨联合距下关节融合术。从受伤到接受截骨融合手术的平均间隔时间为(10.5±4.2)个月,通过踝与后足功能AOFAS评分及VAS视觉疼痛量表评估患者临床预后。记录骨愈合时间,测量并比较术前与末次随访时跟骨Pitch角、距骨倾斜角、后足力线角、距跟高度及跟骨宽度。结果 28例患者随访19~55个月,平均随访时间(32.8±11.8)个月。末次随访时,AOFAS评分及VAS评分较术前显著改善(P<0.001)。影像学评估中所有患者均实现骨性愈合,平均愈合时间(13.1±1.5)周。跟骨Pitch角、距骨倾斜角、后足力线角、距跟高度及跟骨宽度较术前有明显改善(P<0.001)。结论 跟骨滑行截骨联合距下关节融合术可以同时矫正多种畸形,是治疗严重跟骨骨折畸形愈合的有效术式。Objective To investigate the effectiveness of sliding osteotomy combined with subtalar arthrodesis in the treatment of severe calcaneal malunion.Methods From January 2018 to January 2022,28 patients with severe calcaneal malunion were treated with sliding osteotomy combined with subtalar arthrodesis at Honghui Hospital Affiliated to Xi'an Jiaotong University.The mean interval from injury to osteotomy fusion was(10.5±4.2)months.Clinical prognosis was evaluated by American Orthopedic Foot and Ankle Society(AOFAS)scores and visual analog scale(VAS).Calcaneal healing time was recorded.Pitch angle,talar inclination angle,hindfoot alignment angle,talocalcaneal height and calcaneal width were measured and compared between preoperative and last follow-up.Results All 28 patients were followed up for 19 to 55 months,with an average of(32.8±11.8)months.At the last follow-up,AOFAS and VAS scores were significantly improved compared with those before operation(P<0.001).Bone union was achieved in all patients based on imaging evaluation,and the mean healing time was(13.1±1.5)weeks.Pitch angle,talar inclination angle,hindfoot alignment angle,calcaneal width and talocalcaneal height were significantly different from preoperative values(P<0.001).Conclusion Calcaneal sliding osteotomy combined with subtalar arthrodesis can correct multiple deformities simultaneously,and is an effective technique for severe calcaneal malunion.

关 键 词：跟骨骨折畸形愈合 距下关节炎 距下关节融合术 跟骨截骨术 

分 类 号：R658.3[医药卫生—外科学]