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全跟骨切除术后的功能性踝关节重建技术

Functional Ankle Reconstruction Technique After Total Calcanectomy.

机构信息

*Mehmet Ali Aydinlar Acibadem University, Acibadem Maslak Hospital, Istanbul, Turkey.

†Department of Orthopaedics and Traumatology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey.

出版信息

J Am Podiatr Med Assoc. 2024 May-Jun;114(3). doi: 10.7547/21-102.

Abstract

BACKGROUND

Although comminuted fractures, osteomyelitis, large skin ulcers, and malignant tumors are rarely seen in the calcaneus, it is a problematic region to treat because it is not an actual compartment and has insufficient blood supply. Few foot and ankle surgeons would recommend total calcanectomy in various cases of malignant tumors, comminuted fractures, ulcerations of the heel often seen in diabetic patients, and chronic osteomyelitis. After calcanectomy, if functional reconstruction is not performed, the patient will experience loss of function, pain, wound problems, talonavicular dislocations, and additional surgical interventions. In this study, we demonstrate calcanectomy and simultaneous functional reconstruction techniques while discussing the patients' results.

METHODS

We retrospectively evaluated three patients who underwent total calcanectomy between January 1, 2001, and December 31, 2020.Two of these procedures were due to osteomyelitis of the calcaneus after trauma, and one was due to a chondroblastic osteosarcoma of the calcaneus.

RESULTS

The patients were followed up for an average of 116 months. None of the patients developed problems with their wounds in the postoperative term or during follow-up.

CONCLUSIONS

Total calcanectomy as a surgical method of limb salvage yields successful results. We believe that these results can be improved with functional reconstruction and rehabilitation with custom-made shoes, and the results do not entail additional morbidity or require additional hindfoot bone reconstruction.

摘要

背景

尽管跟骨很少发生粉碎性骨折、骨髓炎、大面积皮肤溃疡和恶性肿瘤,但由于它不是一个实际的腔室且血液供应不足,因此是一个治疗棘手的区域。很少有足踝外科医生会在各种恶性肿瘤、粉碎性骨折、糖尿病患者常见的足跟溃疡和慢性骨髓炎的情况下推荐行全跟骨切除术。全跟骨切除术后,如果不进行功能重建,患者会出现功能丧失、疼痛、伤口问题、距下关节脱位和需要额外的手术干预。在本研究中,我们展示了全跟骨切除和同时进行的功能重建技术,并讨论了患者的结果。

方法

我们回顾性评估了 2001 年 1 月 1 日至 2020 年 12 月 31 日期间接受全跟骨切除术的 3 名患者。其中 2 例是由于跟骨创伤后骨髓炎,1 例是由于跟骨软骨母细胞瘤。

结果

患者的平均随访时间为 116 个月。所有患者在术后或随访期间均未出现伤口问题。

结论

全跟骨切除术作为保肢的手术方法可获得成功的结果。我们认为,通过定制鞋进行功能重建和康复,可以改善这些结果,而且不会增加发病率或需要额外的后足骨重建。

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