植骨融合克氏针内固定修复跟骨骨折伴距下关节炎：改良小L入路的评价

摘要

BACKGROUND:Calcaneal fractures with subtalar arthritis were treated with bone graft fusion in the clinic, but previous big “L” approach could cause great trauma to patients, and was not conducive to the patient’s recovery. OBJECTIVE:To explore the repair effect of modified smal “L” approach in bone fusion Kirschner wire on calcaneal fractures with subtalar arthritis. METHODS: Clinical data of 23 patients with calcaneal fracture with subtalar arthritis in the First Hospital-Fengtai Hospital, Peking University from November 2012 to November 2013 were retrospectively analyzed. Al patients received modified bone graft fusionvia smal “L” approach. Repair effect was observed. American Orthopaedic Foot and Ankle Society scores and hind foot scores were evaluated before and after treatment. RESULTS AND CONCLUSION:Bone graft fusion was successfuly conducted in 23 patients. The operation time was 55-90 minutes, averagely (70±2.5) minutes. Al incision was healed wel after operation. Wound infection or flap necrosis did not occur. During folow-up, patients reached bone healing, and no talus osteonecrosis or bone absorption appeared. By the time of the last folow-up, AOFAS score of 23 patients was (85.6±3.7), which was significantly higher than (50.3±6.2) points before treatment (P < 0.05). These results suggest that modified bone graft fusion with smal “L” approach for calcaneal fracture with subtalar arthritis obtained good clinical effects.Moreover, the operation was simple and the complications were less. This method can effectively solve the insufficient exposure of inside of the subtalar joint via previous approaches and big processing difficulty.%背景：临床可以采取植骨融合对跟骨骨折伴距下关节炎患者进行修复治疗，但以往的大“L”入路方式对患者造成较大的创伤，不利于患者的恢复。目的：探讨改良小“L”入路植骨融合克氏针置入内固定对跟骨骨折伴距下关节炎的修复效果，为临床治疗提供参考。方法：回顾性分析北京大学第一医院丰台医院2012年11月至2013年11月收治的23例跟骨骨折伴距下关节炎患者的临床资料，均给予改良小“L”入路植骨融合克氏针置入内固定治疗。观察修复结果并对患者治疗前后的改良美国足踝骨科协会踝与后足评分进行评估。结果与结论：23例患者均顺利完成植骨融合治疗，手术时间55-90 min，平均(70±2.5) min。术后所有患者切口均一期愈合，未出现切口感染或者皮瓣坏死等并发症。经随访，患者均达到骨性愈合，未出现距骨坏死和植骨吸收等现象。末次随访，23例患者的美国足踝骨科协会踝与后足评分为(85.6±3.7)分，显著高于治疗前的(50.3±6.2)分，差异有显著性意义(P <0.05)。表明改良小“L”入路植骨融合克氏针置入内固定修复跟骨骨折伴距下关节炎可以获得良好的效果，且具有操作简单，并发症少等特点，可以有效解决以往入路方式存在的距下关节内侧暴露不足以及处理难度较大等问题。