Lee Hong Seop, Kim Woo Jong, Park Eun Seok, Kim Jun Young, Kim Young Hwan, Lee Young Koo
Department of Foot and Ankle Surgery, Eulji Medical Center, Eulji University, 68, Hangeulbiseok-ro, Nowoungu, Seoul, 01830, Korea.
Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan, Korea.
BMC Musculoskelet Disord. 2019 Jan 29;20(1):43. doi: 10.1186/s12891-019-2419-1.
We hypothesized that calcaneal reconstruction can relieve chronic pain due to calcaneal malunion. We report the mid-term follow-up results of calcaneal reconstruction for calcaneal malunion.
We reviewed the records of 10 male patients (10 ft) who underwent calcaneal reconstruction for calcaneal malunion between January 2009 and July 2014 at the mid-term follow-up. Talocalcaneal height and angle, calcaneal pitch, calcaneal width, Böhler angle, Stephens classification, and Zwipp classification were evaluated by three orthopedic doctors at each visit (pre-reconstruction, post-reconstruction, and at the last follow-up).
The mean follow-up period was 67.1 months (range, 48-101 months). The sites of pain before reconstruction were lateral aspect (4 patients), plantar aspect (3 patients), diffuse pain (2 patients), and anterior aspect (1 patient). There was a significant difference in talocalcaneal height, talocalcaneal angle, calcaneal pitch, calcaneal width, and Böhler angle before and after reconstruction (p < 0.05). There was no significant difference between reconstruction and the last follow-up. Radiological measurement agreement was calculated to be moderate to strong (intraclass correlation coefficient: 0.659-0.988). Mean American Orthopedic Foot & Ankle Society Ankle and Hindfoot score improved from 66.50 ± 9.37 pre-reconstruction to 80.30 ± 8.52 at the last follow-up (p < 0.05). The mean visual analog scale score improved from 8.60 ± 1.43 before reconstruction to 3.40 ± 0.84 at the last follow-up (p < 0.05). Most patients were satisfied with the outcome postoperatively.
Our results showed substantial improvement in the clinical and radiological outcomes after calcaneal reconstruction of calcaneal malunion. This outcome was maintained until the mid-term follow-up. Therefore, calcaneal reconstruction may be a good option for the treatment of chronic pain caused by the malunion of a calcaneal fracture without severe subtalar arthritis. Further prospective studies are needed to test this theory.
Level IV, Retrospective Case Series.
我们推测跟骨重建可以缓解因跟骨畸形愈合引起的慢性疼痛。我们报告了跟骨畸形愈合跟骨重建的中期随访结果。
我们回顾了2009年1月至2014年7月期间10例男性患者（10只足）因跟骨畸形愈合接受跟骨重建的中期随访记录。每次随访（重建前、重建后和最后一次随访）时由三位骨科医生评估距跟高度和角度、跟骨倾斜度、跟骨宽度、Böhler角、Stephens分类和Zwipp分类。
平均随访期为67.1个月（范围48 - 101个月）。重建前疼痛部位为外侧（4例患者）、足底（3例患者）、弥漫性疼痛（2例患者）和前方（1例患者）。重建前后距跟高度、距跟角度、跟骨倾斜度、跟骨宽度和Böhler角有显著差异（p < 0.05）。重建与最后一次随访之间无显著差异。放射学测量一致性计算为中度至高度（组内相关系数：0.659 - 0.988）。美国矫形足踝协会踝与后足平均评分从重建前的66.50 ± 9.37提高到最后一次随访时的80.30 ± 8.52（p < 0.05）。平均视觉模拟量表评分从重建前的8.60 ± 1.43提高到最后一次随访时的3.40 ± 0.84（p < 0.05）。大多数患者对术后结果满意。
我们的结果显示跟骨畸形愈合跟骨重建后临床和放射学结果有显著改善。这一结果在中期随访时得以维持。因此，对于没有严重距下关节炎的跟骨骨折畸形愈合引起的慢性疼痛，跟骨重建可能是一种很好的治疗选择。需要进一步的前瞻性研究来验证这一理论。
IV级，回顾性病例系列。
