Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan, China.
Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan, China.
Arch Orthop Trauma Surg. 2023 Jun;143(6):2845-2854. doi: 10.1007/s00402-022-04449-7. Epub 2022 May 6.
Severe calcaneal malunion is a clinical conundrum for the difficulty of calcaneal reconstruction without soft tissue complications. The aim of this study is to introduce the treatment strategy and preliminary results of staged Illizarov distraction histogenesis and corrective reconstruction for severe malunion of calcaneal fractures.
From June 2014 to May 2020, 14 patients with severe calcaneal malunion treated with the staged strategy were retrospectively analyzed. At the first stage, calcaneal osteotomy and external fixation with Ilizarov frame were performed. The restoration of the approximate configuration of calcaneus and the expansion of contractural soft tissue were achieved by gradual calcaneal distraction. At the second stage, corrective reconstruction was performed and autogenous iliac crest bone graft was used. Clinical and radiographic outcomes were evaluated at final follow-up.
The average time of Ilizarov distraction and total fixation was 21.4 days and 41.0 days at first-stage treatment. At a mean follow-up of 33.1 months, the average American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score increased significantly from 24.0 to 72.4 (p < 0.01). And the mean visual analogue scale (VAS) score had improved remarkably from 8.2 to 2.4 (p < 0.01). Radiographs showed that talocalcaneal height, calcaneal width, calcaneal tuberosity height, hindfoot alignment angle, and talar declination angle were improved to a great extent (p < 0.01). Only one patient had minor pin site infection at first-stage treatment and one got superficial wound infection after second-stage surgery. No wound dehiscence, skin necrosis, or deep infection occurred.
Staged Ilizarov distraction histogenesis and corrective reconstruction is a safe and effective treatment strategy for reducing soft tissue complications and improving reconstruction results in surgical correction of severe calcaneal malunion.
由于跟骨重建时容易出现软组织并发症，因此对于严重的跟骨畸形愈合，如何在不出现软组织并发症的情况下进行跟骨重建是一个临床难题。本研究旨在介绍分期伊利扎洛夫牵张组织发生和矫正重建治疗严重跟骨骨折畸形愈合的治疗策略和初步结果。
回顾性分析 2014 年 6 月至 2020 年 5 月采用分期策略治疗的 14 例严重跟骨畸形愈合患者。一期采用跟骨截骨术和伊利扎洛夫外固定架固定，通过逐渐跟骨牵张恢复跟骨近似形态，扩张挛缩的软组织。二期行矫正重建，自体髂嵴骨移植。最终随访时评估临床和影像学结果。
一期治疗伊利扎洛夫牵张和总固定时间的平均值分别为 21.4 天和 41.0 天。平均随访 33.1 个月后，美国矫形足踝协会（AOFAS）踝与后足评分从 24.0 分显著提高至 72.4 分（p<0.01），视觉模拟评分（VAS）从 8.2 分显著改善至 2.4 分（p<0.01）。影像学显示距下关节高度、跟骨宽度、跟骨结节高度、后足对线角和距骨倾斜角均有明显改善（p<0.01）。仅 1 例患者在一期治疗时出现轻微的针道感染，1 例患者在二期手术后出现浅表伤口感染，均无伤口裂开、皮肤坏死或深部感染。
分期伊利扎洛夫牵张组织发生和矫正重建是治疗严重跟骨畸形愈合的一种安全有效的方法，可减少软组织并发症，改善手术矫正后的重建效果。
