Buch B D, Myerson M S, Miller S D
Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, MD, USA.
Foot Ankle Int. 1996 Feb;17(2):61-70. doi: 10.1177/107110079601700202.
We retrospectively evaluated the results of primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures. Of 108 patients with 112 calcaneal fractures treated at our institution between 1989 and 1992, 16 (15%) underwent primary subtalar arthrodesis through an extensile lateral approach. The calcaneal height and width were restored with standard fixation techniques and then arthrodesis was performed with bone graft and fixation by 7.0-mm cannulated cancellous screws. Fourteen patients (12 males and 2 females; mean age, 40 years) were available for examination at a mean time of 26 months (range, 12-54 months) after surgery. Arthrodesis, evidenced by radiographic bony bridging across the arthrodesis site, was present in all patients between 8 and 12 weeks. Minor wound complications occurred in three patients. Of the 12 patients employed before the injury, 11 returned to their original occupations at a mean time of 8.8 months after injury (range, 1 month to 3 years). The mean AOFAS 100-point clinical rating scale score, evaluating pain, function, and alignment, was 72.4 points (range, 48-88 points). We conclude that primary subtalar arthrodesis is indicated as part of the management of comminuted displaced articular calcaneal fractures, yielding results that allowed 11 of 12 formerly employed patients to return to work.
我们回顾性评估了一期距下关节融合术治疗严重粉碎性跟骨骨折的结果。1989年至1992年间，在我们机构接受治疗的108例患者共112处跟骨骨折中，16例（15%）通过扩大外侧入路接受了一期距下关节融合术。采用标准固定技术恢复跟骨的高度和宽度，然后使用骨移植和7.0毫米空心松质骨螺钉进行固定以实施关节融合术。14例患者（12例男性和2例女性；平均年龄40岁）在术后平均26个月（范围12 - 54个月）时接受检查。所有患者在8至12周时均出现影像学上关节融合部位的骨桥形成，证实关节融合成功。3例患者出现轻微伤口并发症。在受伤前有工作的12例患者中，11例在受伤后平均8.8个月（范围1个月至3年）返回原工作岗位。评估疼痛、功能和对线情况的美国足踝外科协会（AOFAS）100分临床评分量表的平均得分是72.4分（范围48 - 88分）。我们得出结论，一期距下关节融合术是粉碎性移位关节面跟骨骨折治疗的一部分，其结果使12例受伤前有工作的患者中的11例能够重返工作岗位。
