Huang P J, Fu Y C, Cheng Y M, Lin S Y
Department of Orthopaedic Surgery, Kaohsiung Medical College, Taiwan, Republic of China.
Foot Ankle Int. 1999 Mar;20(3):166-70. doi: 10.1177/107110079902000305.
Primary subtalar arthritis is not common. In most cases, it is the late sequela of intra-articular calcaneal fracture. Subtalar arthrodesis is mostly used for the treatment of traumatic subtalar arthritis in our clinics. We have compared our early cases of in-situ subtalar fusion with our recent cases of fusion with sliding corrective osteotomy in this clinical report. From 1989 to 1992, 15 feet of 13 patients were treated with subtalar arthrodeses for subtalar arthritis caused by malunion of calcaneal fractures. Fusion in situ was done by Ollier's approach, and resection of bony protrusion was done if there was lateral entrapment syndrome. From 1992 to 1995, 13 feet of 12 patients also received subtalar arthrodeses to salvage their calcaneal fractures, but the subtalar fusion was done by wide lateral approach, calcaneal sliding corrective osteotomy, and sometimes (11 of 13 feet) with Achilles tendon lengthening to restore the calcaneal height and width. Patients of both groups experienced obvious clinical improvement in subtalar pain relief, but there was no difference with walking distance, running, or jumping. The group undergoing fusion with sliding corrective osteotomy was more satisfied with regard to cosmetic results and shoe wear. The overall satisfactory rate in the group who underwent fusion with sliding corrective osteotomy (92%) was superior to the group who underwent fusion in situ (77%). Though our method of sliding corrective osteotomy does not provide much improvement to the talus declination angle, it is suitable for those patients with a "banana"-shaped calcaneus malunion. If the patient has prominent anterior ankle pain caused by tibiotalar impingement, we believe that a distraction subtalar arthrodesis would be more appropriate.
原发性距下关节炎并不常见。在大多数情况下，它是跟骨关节内骨折的晚期后遗症。在我们的诊所中，距下关节融合术主要用于治疗创伤性距下关节炎。在本临床报告中，我们比较了早期原位距下融合病例与近期采用滑动矫正截骨术进行融合的病例。1989年至1992年，13例患者的15足接受了距下关节融合术，以治疗跟骨骨折畸形愈合导致的距下关节炎。采用奥里尔方法进行原位融合，如有外侧卡压综合征则切除骨突。1992年至1995年，12例患者的13足也接受了距下关节融合术以挽救其跟骨骨折，但距下融合术采用广泛外侧入路、跟骨滑动矫正截骨术，有时（13足中的11足）还进行跟腱延长术以恢复跟骨的高度和宽度。两组患者在距下疼痛缓解方面均有明显的临床改善，但在行走距离、跑步或跳跃方面没有差异。采用滑动矫正截骨术进行融合的组对美容效果和鞋类穿着更满意。采用滑动矫正截骨术进行融合的组的总体满意率（92%）高于原位融合组（77%）。虽然我们的滑动矫正截骨术方法对距骨倾斜角的改善不大，但它适用于那些跟骨呈“香蕉”形畸形愈合的患者。如果患者因胫距撞击而出现明显的前踝疼痛，我们认为撑开式距下关节融合术会更合适。
