Zhang Lei, Chen Yusheng, Wang Xinwei, Hua Haotian, Sheng Jingya, Chen Jiangfei, Guo Zairan
No.1 Department of Osteomyelitis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China.
Department of VIP, the Second Affiliated Hospital of Henan University of Science and Technology, Luoyang Henan, 471000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Mar 15;35(3):323-329. doi: 10.7507/1002-1892.202010064.
To investigate the effectiveness of simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique.
Between January 2014 and August 2020, 6 cases of traumatic calcaneal osteomyelitis with defect deformities were treated by simultaneous treatment of near-arc bone transport by Ilizarov technique. The patients were all male; aged from 40 to 61 years (mean, 49.3 years). The disease duration was 2-72 months, with an average of 16.1 months. All patients were traumatic calcaneal osteomyelitis, including 4 cases of falling from height, 1 case of traffic accident injury, and 1 case of crushing injury. The infection affected the talar-heel joint in 4 cases, and the talar-heel joint was fused or partially fused in 2 cases. After the external fixator was removed, the Maryland foot scoring system was used to evaluate the foot function, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot function scoring system was used to evaluate the ankle-hindfoot function, and were compared with the preoperative scores.
All patients were followed up 1.5-26.0 months, with an average of 16.3 months. All incisions healed by first intention, no recurrence of infection occurred, and no surgical intervention such as second-stage bone grafting and fusion was performed. Five cases of calcaneal osteomyelitis with defect deformity underwent one-stage osteotomy and slipped, 1 case of the original bone mass after debridement after infection of calcaneal fractures slipped directly. The bone sliding time was 28-62 days, with an average of 38.7 days; the sliding distance was 3.1-5.2 cm, with an average of 3.6 cm. In 1 patient, due to the short follow-up time, the calcaneal slip bone had not healed, the external fixator had not been removed (not involved in clinical scoring), but the foot shape, reexamination of X-ray films and with frame walking were satisfactory. The time with external fixator was 6-8 months, with an average of 6.5 months in the other 5 cases. After removing the external fixator, the foot returned to three-point weight-bearing, and the longitudinal arch was recovered to varying degrees, and there was no obvious varus valgus. The Maryland score after removal of the external fixator was 80.8±4.7, which was significantly higher than that before operation (33.6±4.3) ( =-35.782, =0.000), 3 cases were excellent and 2 cases were good; the median AOFAS ankle-hindfoot score was 84, the interquartile range was (79, 86), which was significantly improved when compared with the preoperative score [the median score was 33.5, the interquartile range was (21.3, 37.5)] ( =-2.023, =0.043), 4 cases were excellent and 1 case was good. Among them, pain, walking distance, getting rid of walking aids, going up and down stairs, deformity, were significantly improved when compared with preoperative ones. Mobility such as subtalar and hock joints were poor or disappeared.
Simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique can optimize the operation method, reduce the number of operations, and try to simulate the original shape of the calcaneus. It is an effective, economical, and novel treatment method.
探讨采用Ilizarov技术同期治疗创伤性跟骨骨髓炎并缺损畸形的疗效。
2014年1月至2020年8月，采用Ilizarov技术同期治疗创伤性跟骨骨髓炎并缺损畸形患者6例。患者均为男性，年龄40～61岁（平均49.3岁）。病程2～72个月，平均16.1个月。所有患者均为创伤性跟骨骨髓炎，其中高处坠落伤4例，交通事故伤1例，挤压伤1例。感染累及距下关节4例，距下关节融合或部分融合2例。拆除外固定器后，采用马里兰足部评分系统评估足部功能，采用美国矫形足踝协会（AOFAS）踝后足功能评分系统评估踝后足功能，并与术前评分进行比较。
所有患者均获随访1.5～26.0个月，平均16.3个月。所有切口均一期愈合，无感染复发，未行二期植骨融合等手术干预。5例跟骨骨髓炎并缺损畸形患者行一期截骨滑移，1例跟骨骨折感染清创后原骨块直接滑移。骨滑移时间28～62天，平均38.7天；滑移距离3.1～5.2 cm，平均3.6 cm。1例患者因随访时间短，跟骨滑移骨未愈合，外固定器未拆除（未纳入临床评分），但足部外形、X线片复查及带架行走情况满意。外固定器佩戴时间6～8个月，其余5例平均6.5个月。拆除外固定器后，足部恢复三点负重，纵弓不同程度恢复，无明显内外翻。拆除外固定器后马里兰评分80.8±4.7，显著高于术前（33.6±4.3）（t=-35.782，P=0.000），优3例，良2例；AOFAS踝后足评分中位数为84，四分位数间距为（79，86），与术前评分[中位数为33.5，四分位数间距为（21.3，37.5）]比较显著改善（Z=-2.023，P=0.043），优4例，良1例。其中，疼痛、行走距离、摆脱助行器、上下楼梯、畸形等与术前比较均显著改善。距下关节和跗横关节等活动度较差或消失。
采用Ilizarov技术同期治疗创伤性跟骨骨髓炎并缺损畸形可优化手术方式，减少手术次数，尽量模拟跟骨原始形态，是一种有效、经济、新颖的治疗方法。
