Wang Shouli, Zhou Xiaobo, Liang Junbo, Liu Fucun, Wang Bin
Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Taizhou, China.
Department of Orthopedics, Changzheng Hospital of Shanghai, Shanghai, China.
ANZ J Surg. 2019 Apr;89(4):329-333. doi: 10.1111/ans.15133. Epub 2019 Mar 14.
The traditional extended lateral approach for calcaneus fractures can provide sufficient exposure for reduction, but complications are frequent. The minimally invasive approach does limited damage to the soft tissue and its complication rate is low, but provides limited surgical exposure for complicated fracture. Thus, an approach that could provide wide exposure with less soft tissue injury is important.
The lateral bone flap approach, we proposed, involved the same incision as the extended lateral approach. After incision, osteotomy was performed around the lateral bulged wall of the calcaneus without dissection of soft tissue. The lateral wall was free from calcaneus and connected with the soft tissue, and the lateral bone flap was developed. The reduction of fracture and the fixation of plate were performed as usual. Next, the bone flap was reduced and sutured. This retrospective study of lateral bone flap approach included 63 cases of 58 patients with displaced intra-articular calcaneus fractures from January 2011 to January 2015. Clinical and radiological outcomes and complications were all recorded.
Radiological outcome was significantly improved at 3 months and 2 years post-operatively compared with that of pre-operatively (P < 0.01). The Maryland Foot Score at the last follow up was 87.2 ± 7.0. The excellent/good rate was 90.5%. One case of delayed wound healing occurred. No infection or sural nerve injury occurred.
The lateral bone flap approach is simple, safe and effective for displaced intra-articular calcaneus.
跟骨骨折传统的外侧延长入路可为骨折复位提供充分暴露，但并发症频发。微创入路对软组织损伤有限且并发症发生率低，但对于复杂骨折的手术暴露有限。因此，一种能在减少软组织损伤的同时提供广泛暴露的入路很重要。
我们提出的外侧骨瓣入路与外侧延长入路切口相同。切开后，在跟骨外侧膨隆壁周围进行截骨，不剥离软组织。将外侧壁与跟骨分离并与软组织相连，形成外侧骨瓣。按常规进行骨折复位和钢板固定。然后，将骨瓣复位并缝合。这项关于外侧骨瓣入路的回顾性研究纳入了2011年1月至2015年1月期间58例移位的关节内跟骨骨折患者中的63例。记录临床、影像学结果及并发症情况。
与术前相比，术后3个月和2年时影像学结果有显著改善（P < 0.01）。末次随访时马里兰足部评分87.2 ± 7.0。优良率为90.5%。发生1例伤口延迟愈合。未发生感染或腓肠神经损伤。
外侧骨瓣入路治疗移位的关节内跟骨骨折简单、安全且有效。
