Zwipp H, Rammelt S
Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden.
Zentralbl Chir. 2003 Mar;128(3):218-26. doi: 10.1055/s-2003-38536.
Posttraumatic foot deformities requiring correction result from overlooked or inadequately treated injuries and, on the other hand, from protracted courses because of avascular necrosis, non-union or infection after primary surgery. To achieve a maximum benefit, corrective surgery has to be carried out early before arthritic involvement of adjacent joint becomes evident. As salvage procedures, arthrodeses should be restricted to the affected joints. Especially talus malunion and non-union should be corrected with preservation of the joints whenever possible to achieve favourable functional outcomes. In case of calcaneal malunion with consequential lateral translation a reorientating subtalar arthrodesis should be supplemented by corrective osteotomy of the fracture line. Corrections at the level of Chopart's and Lisfranc's (mid-tarsal and tarsometatarsal) joints must restore the exact relationship between the medial and lateral foot columns. Malunions of the metatarsals and toes are corrected in cases of symptomatic malalignment. This paper reviews corrective procedures for posttraumatic deformities at the different foot regions. A therapy-based classification for mal-unions of the talus and calcaneus is proposed.
需要矫正的创伤后足部畸形,一方面源于被忽视或治疗不充分的损伤,另一方面源于初次手术后因缺血性坏死、骨不连或感染导致的病程迁延。为了获得最大益处,矫正手术必须在相邻关节出现关节炎病变之前尽早进行。作为挽救性手术,关节融合术应仅限于受影响的关节。特别是距骨畸形愈合和骨不连,应尽可能保留关节进行矫正,以获得良好的功能结果。对于伴有继发外侧移位的跟骨畸形愈合,重新定向的距下关节融合术应辅以骨折线的矫正截骨术。Chopart关节和Lisfranc关节(中跗关节和跗跖关节)水平的矫正必须恢复足内侧柱和外侧柱之间的确切关系。有症状性畸形排列的跖骨和趾骨畸形愈合需进行矫正。本文综述了不同足部区域创伤后畸形的矫正手术。提出了基于治疗的距骨和跟骨畸形愈合分类方法。