| 四种手术方式行距下关节融合术治疗陈旧性跟骨骨折的疗效观察 |
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投稿时间：2019-05-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 李平 |
LI Ping |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichuan, China |
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| 张挥武 |
ZHANG Hui-wu |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichuan, China |
985839846@qq.com |
| 张宇 |
ZHANG Yu |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichuan, China |
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| 徐善强 |
XU Shan-qiang |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichuan, China |
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| 张文举 |
ZHANG Wen-ju |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichuan, China |
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| 王勇 |
WANG Yong |
四川省骨科医院, 四川 成都 610041 |
Sichuan Province Orthopaedics Hospital, Chengdu 610041, Sichuan, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第11期，第1038-1043页 |
| DOI：10.3969/j.issn.1003-0034.2019.11.012 |
| 基金项目: |
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中文摘要:
目的：观察采用4种手术方式行距下关节融合内固定术治疗陈旧性跟骨骨折的临床疗效。
方法：自2014年3月至2017年11月，采用4种手术方式行距下关节融合术治疗陈旧性跟骨骨折25例（26足），年龄23~70（36.7±5.8）岁，病程3~35（9.5±5.1）个月，距下关节原位融合术2例（2足），距下关节撑开植骨融合术6例（7足），跟骨“V”形截骨距下关节融合术6例（6足），跟骨体斜行截骨联合距下关节植骨融合术11例（11足）。观察患者手术并发症情况；比较术前及术后12个月距骨倾斜角、跟骨Böhler角、Gissane角、跟距高度，术后12个月时采用视觉模拟评分（visual analogue score，VAS）及美国足踝外科协会（American Orthopedic Foot and Ankle Society，AOFAS）踝与后足评分评估手术疗效。
结果：21例（21足）患者获得随访，时间13~34（20.1±3.7）个月，4例（5足）失访。术后2例手术切口裂开，1例骨折不愈合，其余病例未发生骨折不愈合及内固定松动或断裂等并发症。术前与术后12个月距骨倾斜角［（5.3±2.4）° vs（11.2±4.6）°，t=7.24，P<0.05］，跟骨Böhler角［（5.4±2.7）° vs（25.5±5.3）°，t=11.2，P<0.05］，Gissane角［（89.4±9.6）° vs（122.0±5.2）°，t=8.13，P<0.05］，跟距高度［（28.5±5.1）mm vs（47.1±3.7）mm，t=6.45，P<0.05］比较差异有统计学意义。术后12个月VAS评分1.6±0.7，较术前5.2±1.0明显改善（t=5.12，P<0.05）；术后12个月AOFAS评分86.2±5.2，较术前52.4±6.4明显提高（t=6.41，P<0.05）；其中优14足，良4足，可2足，差1足。
结论：距下关节原位融合术、距下关节撑开植骨融合术、跟骨“V”形截骨距下关节融合术、跟骨体斜行截骨联合距下关节植骨融合术均为治疗陈旧性跟骨骨折的有效手术方式，具有缓解疼痛、纠正跟骨畸形、改善足部功能等优点，严格掌握各种手术方式的适应证是保证手术疗效的关键。 |
| 【关键词】跟骨 骨折 关节融合术 |
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| Four kinds of operative methods for subtalar arthrodesis in treating old calcaneal fracture |
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ABSTRACT
Objective: To explore clinical efficacy of four surgical methods for subtalar joint fusion and internal fixation in treating old calcaneal fractures.
Methods: From March 2014 to November 2017,25 patients (26 feet) with old calcaneal fractures treated with four surgical methods of subtalar arthrodesis were retrospectively analyzed,including subtalar joint fusion in situ for 2 patients (2 feet),subtalar articular strut bone graft fusion for 6 patients (6 feet),subtalar joint fusion with calcaneus V-shaped osteotomy for 6 patients(6 feet),and subtalar bone graft fusion with calcaneus cuneiform osteotomy for 11 patients (11 feet). They aged from 23 to 70 years old with an average of (36.7±5.8) years old,and the courses of disease ranged from 3 to 35 months with an average of (9.5±5.1) months. Postoperative complications were observed,talar tilt angle,calcaneus Böhler angle,Gissane angle,and the heel height were compared before and after surgery at 12 months. VAS score and American Orthopaedic Foot and Ankle Society(AOFAS) score were employed to evaluate clinical efficacy at 12 months after surgery.
Results: Twenty-one patients (21 feet) were followed up for 13 to 34 months with an average of (20.1±3.7) months,four patients(5 feet) were lost to follow-up. Two patients were underwent surgical incision rupture,1 patient occurred fracture nonunion,and no complications such as fracture nonunion,loosening or fracture of internal fixation occurred in the other patients. There were significant differences between preoperative and postoperative in talar tilt angle[(5.3±2.4)° vs (11.2±4.6)°,t=7.24,P<0.05],calcaneus Böhler angle[(5.4±2.7)° vs(25.5±5.3)°,t=11.2,P<0.05],Gissane angle[(89.4±9.6)° vs (122.0±5.2)°,t=8.13,P<0.05],and heel height[(28.5±5.1) mm vs(47.1±3.7) mm,t=6.45,P<0.05]. VAS score was decreased from 5.2±1.0 before operation to 1.6±0.7 at 12 months after operation(t=5.12,P<0.05);AOFAS score was improved from 52.4±6.4 to 86.2±5.2 at 12 months after operation(t=6.41,P<0.05);14 feet got excellent results,4 good,2 moderate and 1 poor.
Conclusion: Subtalar joint fusion in situ,subtalar articular strut bone graft fusion,subtalar joint fusion with calcaneus V-shaped osteotomy,and subtalar bone graft fusion with calcaneus cuneiform osteotomy are effective operation methods for old calcaneal fractures,which have advantages of relieving pain,correcting deformity of calcaneal,improving foot function. Reasonable selection and treatment is the key to ensure the efficacy. |
| KEY WORDS Calcaneus Fractures Arthrodesis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李平,张挥武,张宇,徐善强,张文举,王勇.四种手术方式行距下关节融合术治疗陈旧性跟骨骨折的疗效观察[J].中国骨伤,2019,32(11):1038~1043 |
| 英文格式: | LI Ping,ZHANG Hui-wu,ZHANG Yu,XU Shan-qiang,ZHANG Wen-ju,WANG Yong.Four kinds of operative methods for subtalar arthrodesis in treating old calcaneal fracture[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(11):1038~1043 |
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