Jardé O, Trinquier J L, Renaux P, Mauger S, Vives P
Service d'orthopédie traumatologie, Hôpital Nord, Amiens.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(8):728-33.
57 subtalar arthrodesis for sequelae of calcaneal fractures were reviewed with a minimum follow up of 6 years 11 months.
Bone resection and interposition of bone grafts, stabilized by screws were used in 36 cases. Iliac crest grafts were used in 20 cases, cryopreserved grafts 15 times and local graft taken on the anterior tibial epiphysis once. No surgery was performed on the mid foot.
Results were evaluated using the grading system described by Mestdagh with 33 good global results, 18 fair results and 6 poor results for a total of only 58 per cent of good global results. Of the 57 cases reviewed, 18 remained painful with a limited range of motion for inversion and eversion of the foot. In 18 patients monopodal weight-bearing was unstable. Residual oedema persisted in 5 patients. 16 patients continued to limp and 3 required the use of a crutch. 7 valgus and 3 varus deviations of the hindfoot were noted at follow up with poor tolerance of the varus when compared to exaggerated valgus. Podoscopic examination revealed increase anterior pressure zones responsible for metatarsalgia which was relieved by corrective shoe inserts in 10 patients. Radiographic evidence of fusion could be demonstrated in 55 cases. There was little or no repercussion on the tibio-talar joint. In the Chopart joint we noted 4 cases of osteoarthritis; there were 6 lesions in the talo-navicular joint and no repercussion in Lisfranc's joint. 16 complications of varying severity were noted with 2 nonunions following use of cryopreserved grafts.
Subtalar arthrodesis for sequelae of traumatic lesion in the hindfoot gives good results in 2 cases out of 3. In our series, 26 per cent of the patients showed degenerative changes in the mid foot unlike the series published by Kempf. As Meary and Mestdagh noted, we found that residual varus or valgus deformity > 10 degrees was poorly tolerated as well as modifications > 20-30 degrees in the vertical ratio between the talus and the calcaneum in the horizontal plane.
Subtalar arthrodesis is a useful technique giving good results in 2 out of 3 cases of traumatic sequelae in the hindfoot. Triple arthrodesis does not seem indicated when the talus and the calcaneus can be realigned before fusion. Talo-navicular arthrodesis, though more easily realized, requires blocking a normal joint in order to immobilize a painful joint.
回顾57例距下关节融合术治疗跟骨骨折后遗症的病例，最短随访时间为6年11个月。
36例采用螺钉固定的骨切除及骨移植术。20例采用髂嵴移植，15例采用冷冻保存移植，1例采用胫骨近端骨骺局部移植。中足未行手术。
采用Mestdagh描述的分级系统评估结果，总体结果良好的有33例，中等的有18例，差的有6例，总体良好结果仅占58%。在回顾的57例病例中，18例仍有疼痛，足内翻和外翻活动范围受限。18例患者单足负重不稳定。5例患者残留水肿持续存在。16例患者继续跛行，3例需要使用拐杖。随访时发现7例后足外翻和3例内翻畸形，与过度外翻相比，内翻耐受性差。足镜检查显示前足压力区增加导致跖痛，10例患者通过矫正鞋垫缓解。55例有融合的影像学证据。对胫距关节几乎没有或没有影响。在Chopart关节，我们发现4例骨关节炎；距舟关节有6处病变，Lisfranc关节无影响。记录到16例不同严重程度的并发症，使用冷冻保存移植后有2例骨不连。
距下关节融合术治疗后足创伤性病变后遗症，三分之二的病例效果良好。在我们的系列研究中，26%的患者中足出现退行性改变，与Kempf发表的系列研究不同。正如Meary和Mestdagh所指出的，我们发现残留内翻或外翻畸形>10度耐受性差，以及距骨和跟骨在水平面的垂直比例改变>20 - 30度耐受性也差。
距下关节融合术是一种有用的技术，在三分之二的后足创伤后遗症病例中效果良好。当距骨和跟骨在融合前可重新对线时，似乎不需要进行三关节融合术。距舟关节融合术虽然更容易实施，但需要固定一个正常关节以固定疼痛关节。
