Flemister A S, Infante A F, Sanders R W, Walling A K
Mary Imogene Bassett Hospital, Cooperstown, New York 13326, USA.
Foot Ankle Int. 2000 May;21(5):392-9. doi: 10.1177/107110070002100506.
Eighty six subtalar arthrodeses performed between 1985 and 1996 for complications associated with intra-articular calcaneal fractures were retrospectively evaluated. Patients were divided into three Groups: (I) 59 patients with calcaneal malunions (II) 13 patients with failed open reduction and internal fixation, and (III) eight patients undergoing open reductions and primary fusion for highly comminuted fractures. In each scenario, internal fixation was achieved with cancellous lag screws. Bone graft material consisted of either autogenous iliac crest graft, local graft obtained from the lateral wall exostectomy of the malunion, or freeze-dried cancellous allograft. Fusions in Groups II and III were performed in situ. Fusions in Group I were performed either in situ or utilizing a variety of reconstructive procedures depending upon the type of malunion encountered. Eighty three of the 86 fusion attempts were successful following the initial operations for a union rate of 96%. Fusion rates were similar regardless of the graft material used. Complications included four varus malunions, four cases of osteomyelitis, and two cases of reflex sympathetic dystrophy. A statistically significant shorter hospital stay was found for patients not undergoing iliac crest bone graft procedures. Eighty patients with at least two year follow up achieved a mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of 75.0. Scores were similar for all three groups and for the various types of reconstructive procedures used. No correlation was found between postoperative talar declination angle and the AOFAS ankle-hindfoot score. Worker's compensation patients tended to have a poorer clinical outcome.
对1985年至1996年间因关节内跟骨骨折并发症而进行的86例距下关节融合术进行了回顾性评估。患者分为三组：（I）59例跟骨畸形愈合患者；（II）13例切开复位内固定失败患者；（III）8例因高度粉碎性骨折而行切开复位一期融合术的患者。在每种情况下，均使用松质拉力螺钉进行内固定。骨移植材料包括自体髂嵴骨移植、取自畸形愈合外侧壁骨突切除术的局部移植骨或冻干松质骨同种异体骨。第二组和第三组的融合术在原位进行。第一组的融合术根据所遇到的畸形愈合类型在原位进行或采用各种重建手术。86次融合尝试中有83次在初次手术后成功，融合率为96%。无论使用何种移植材料，融合率相似。并发症包括4例内翻畸形愈合、4例骨髓炎和2例反射性交感神经营养不良。未进行髂嵴骨移植手术的患者住院时间在统计学上显著缩短。80例至少随访两年的患者美国矫形足踝协会（AOFAS）踝-后足平均评分为75.0。三组以及所采用的各种重建手术的评分相似。术后距骨倾斜角与AOFAS踝-后足评分之间未发现相关性。工伤赔偿患者的临床结局往往较差。
