Deorio James K, Leaseburg J Thaddeus, Shapiro Shane A
Department of Orthopedic Surgery, Duke University, Durham, NC, USA.
Foot Ankle Int. 2008 Dec;29(12):1189-94. doi: 10.3113/FAI.2008.1189.
Subtalar arthrodesis is a common procedure for treating subtalar arthrosis. An isolated lateral incision can be used as an approach to subtalar fusion alone. However, it can be a difficult approach for correction of varus or valgus hindfoot deformities through the subtalar joint; especially if it involves distraction to correct calcaneal alignment. Less commonly, two-incision or single-incision medial approaches also have been described, but distraction and angular correction can still be difficult. We present an alternative method, using a posterior Achilles tendon-splitting procedure, that gives excellent subtalar exposure and the ability to obtain distraction with angular correction and bone grafting.
Six consecutive patients underwent subtalar fusion with a posterior approach. Both varus and valgus deformities secondary to trauma, tendon insufficiency, or congenital deformities were corrected. Distraction was accomplished with laminar spreaders, and fixation was obtained with two 7.3-mm partially threaded cannulated screws. All patients were followed until fusion, and clinical and radiographic results were recorded. No other concomitant procedures were performed.
Fusion was observed radiographically in all patients by 3 months postoperatively. No serious wound complications occurred. Correction to slightly valgus alignment (for varus deformity) or neutral alignment (for valgus deformity) was obtained without collapse of autologous bone graft. Talocalcaneal height and all angular measurements were significantly increased (all p < 0.05).
The posterior approach for distraction arthrodesis is an alternative to the standard lateral approach technique. It allows safe exposure with the ability to distract while also correcting varus or valgus deformity of the subtalar joint.
距下关节融合术是治疗距下关节病的常见手术。单纯的外侧切口可作为距下关节融合术的一种入路方式。然而，通过距下关节纠正内翻或外翻后足畸形可能是一种困难的入路方式；尤其是当需要牵张来纠正跟骨对线时。较少见的是，也有文献描述了双切口或单切口内侧入路，但牵张和角度矫正仍可能困难。我们提出一种替代方法，即采用后入路跟腱劈开术，该方法能提供良好的距下关节暴露，并具备在进行角度矫正和植骨的同时实现牵张的能力。
连续6例患者采用后入路进行距下关节融合术。纠正了创伤、肌腱功能不全或先天性畸形继发的内翻和外翻畸形。使用椎板撑开器进行牵张，并用两枚7.3毫米部分螺纹空心螺钉进行固定。所有患者均随访至融合，并记录临床和影像学结果。未进行其他同期手术。
术后3个月时，所有患者影像学检查均显示融合。未发生严重伤口并发症。在自体骨移植未塌陷的情况下，实现了向内翻畸形患者的轻度外翻对线或外翻畸形患者的中立对线的矫正。距骨-跟骨高度及所有角度测量值均显著增加（均P<0.05）。
后入路撑开融合术是标准外侧入路技术的一种替代方法。它能安全暴露，具备牵张能力，同时还能纠正距下关节的内翻或外翻畸形。
