中国修复重建外科杂志

中国修复重建外科杂志

距下关节撑开植骨融合术在跟骨骨折畸形愈合治疗中的应用研究

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目的 对距下关节撑开植骨融合术在跟骨骨折畸形愈合治疗中的应用进行综述。 方法 广泛查阅国内外有关距下关节撑开植骨融合术治疗跟骨骨折畸形愈合的文献,对其发展历史、手术方法、术后问题、适应证以及疗效等进行总结分析。 结果 距下关节撑开植骨融合术是治疗跟骨骨折畸形愈合的主要术式之一,手术包括距下关节融合和植入骨块矫正后足畸形两部分。与其他治疗方式相比,距下关节撑开植骨融合术可以有效矫正跟骨畸形愈合引起的并发症,恢复距骨、跟骨的高度以及矫正距骨倾斜角的丧失,缓解疼痛。该术式手术操作相对简便,手术并发症少,临床效果相对满意,可有效降低跟骨骨折畸形愈合患者的病残率,改善患者生活质量。 结论 距下关节撑开植骨融合术在跟骨畸形愈合的治疗中取得了显著进展,但其存在术后骨不愈合及植入骨块吸收等缺陷,尚需进一步研究。

Objective To review the application and research progress of subtalar distraction arthrodesis with bone graft block interposition in the treatment of calcaneus fracture malunion. Methods The recent literature concerning the history, surgical technique, postoperative complication, indications, and curative effect of subtalar distraction arthrodesis with bone graft block interposition in the treatment of calcaneus fracture malunion was summarized and analyzed. Results Subtalar distraction arthrodesis with bone graft block interposition is one of the main ways to treat calcaneus fracture malunion, including a combined surgery with subtalar arthrodesis and realignment surgery for hindfoot deformity using bone block graft. The advantage is on the base of subtalar joint fusion, through one-time retracting subtalar joint, the posterior articular surface of subtalar joint implants bone-block can partially restore calcaneal height, thus improving the function of the foot. Compared with other calcaneal malunion treatments, subtalar distraction arthrodesis is effective to correct complications caused by calcaneus fracture malunion, and it can restore the height of talus and calcaneus, correct loss of talocalcaneal angle, and ease pain. Conclusion Subtalar distraction arthrodesis with bone graft block interposition has made remarkable progress in the treatment of calcaneus fracture malunion, but it has the disadvantages of postoperative nonunion and absorption of bone graft block, so further study is needed.

关键词: 跟骨骨折畸形愈合; 距下关节撑开融合术; 骨移植

Key words: Calcaneus fracture malunion; subtalar distraction arthrodesis; bone-block graft

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