Eid Mohamed A M, El-Soud Maged Abou, Mahran Mahmoud A, El-Hussieni Timour F
Department of Orthopaedic Surgery, Ain Shams University, Cairo, Egypt.
Strategies Trauma Limb Reconstr. 2010 Apr;5(1):39-45. doi: 10.1007/s11751-010-0081-0. Epub 2010 Mar 4.
Sixteen patients underwent minimally invasive subtalar arthrodesis through a mini-invasive approach with posterior iliac graft between 2004 and 2006. No hardware was used to transfix the arthrodesis and partial weight bearing was allowed immediately. The primary indication for surgery was the squeal of fracture os calcis in terms of subtalar joint arthritis, loss of heel height, malalignment of the hindfoot, and pain with weight bearing. There were 12 male and 4 female patients with a mean age of 30 (range 17-52). Patients were followed up for a period of 40.8 months (range 36-48 months). The mean interval from injury to fusion was 2 (+0.6) years ranging from 6 months to 6 years post fracture. The average clinical rating scale based on the American Orthopaedic Foot and Ankle Society (AOFAS) improved from 36 preoperatively to 78 at the latest follow-up (P < 0.05). Union rate was 94%. Radiographic evaluation revealed a mean increase in calcaneal inclination of 6.25 + 8.3 degrees (P < 0.07) and a mean increase in the lateral talocalcaneal angle of 7.42 + 10.2 degrees (P < 0.08). Complications were graft nonunion in 1 patient and transient tendoachilles tendinitis in another. This technique can be used to decrease the morbidity associated with the late complications of os calcis fractures by aligning the hindfoot, restoring the heel height and correcting calcaneal and talar inclination. It offers the advantage of early weight bearing while avoiding hardware complications.
2004年至2006年期间，16例患者通过微创入路行距下关节融合术，并采用髂后骨移植。未使用内固定物固定关节融合，术后立即允许部分负重。手术的主要适应证是跟骨骨折后出现距下关节关节炎、足跟高度丢失、后足畸形以及负重时疼痛。患者中男性12例，女性4例，平均年龄30岁（17 - 52岁）。患者随访时间为40.8个月（36 - 48个月）。从受伤到融合的平均间隔时间为2（±0.6）年，骨折后6个月至6年不等。基于美国矫形足踝协会（AOFAS）的平均临床评分从术前的36分提高到最近一次随访时的78分（P < 0.05）。融合率为94%。影像学评估显示跟骨倾斜度平均增加6.25 ± 8.3度（P < 0.07），距跟外侧角平均增加7.42 ± 10.2度（P < 0.08）。并发症包括1例植骨不愈合和另1例短暂性跟腱炎。该技术可通过矫正后足、恢复足跟高度以及纠正跟骨和距骨倾斜度，降低跟骨骨折晚期并发症的发生率。它具有早期负重的优势，同时避免了内固定物相关并发症。
