目的:跟骨缺损仍然具有挑战性,重建策略有限。目前的方法,包括移植物移植,替换,和牵张成骨,显示出有限的优点和某些缺点。当前的跟骨延长部分跟骨丢失重建需要小于35%的骨丢失。我们介绍了tal骨融合和逐渐延长方法的组合,以治疗跟骨大量丢失。
方法:从2015年1月至2021年12月,对6例单侧跟骨结节大量创伤性丢失患者进行了tal骨融合和跟骨逐渐延长。进行了一项回顾性研究以评估这种新技术的结果。根据美国骨科足踝评分(AOFAS)评估临床结果。评估了放射学数据,其中包括胫骨-跟骨角度(TCA),跟骨交界角(CIA),跖骨偏角(MDA),纵向拱角(ALA),和跟骨轴向延长量(CAL)。
结果:平均跟骨轴向延长为43.8±3.1mm(范围,39-49.5mm),加长跟骨的平均比例为47.8%±3.7%(范围,42.8-55.3%)。平均外固定时间为104.8±67.5天(范围,69至242天),平均外固定指数为2.4±1.6天/cm。所有患者均坚持术后随访计划,平均随访时间(FT)为35.0±6.7个月(范围,26-40个月)。受伤肢体的畸形均根据射线照相术进行纠正。根据AOFAS,取得了三个优秀和三个好成绩。
结论:Ilizarov技术仍然是跟骨重建的一种选择,一旦与tal骨融合结合,就会产生大量的跟骨缺损。在我们的研究中,使用这些技术可以令人满意地恢复受伤的脚和脚踝的功能。除了跟骨伸长,tal骨融合在某种程度上是必要的,以加强分散的跟骨的近端部分,以产生更大的分散骨痂,矫正伴随的足部畸形,增强后脚稳定性。当有必要灵活选择时,应该融合tar骨。
OBJECTIVE: Calcaneus defect remains challenging with limited strategies for reconstruction. Current methods, including graft transplantation, substitution, and distraction osteogenesis, showed limited advantages with certain shortcomings. Current calcaneus lengthening for partial calcaneus loss reconstruction requires bone loss of less than 35%. We introduced our combination of tarsal bone fusion and gradual lengthening method in treating massive calcaneus loss.
METHODS: From January 2015 to December 2021, tarsal bone fusion and calcaneus gradual lengthening were performed in six patients with unilateral massive traumatic loss of the calcaneal tuberosity. A retrospective study was held to evaluate the outcomes of this novel technique. Clinical outcomes were assessed based on the American Orthopedic Foot and Ankle Score (AOFAS). Radiological data were assessed, which included tibio-calcaneal angle (TCA), calcaneal interface angle (CIA), metatarsal declination angle (MDA), angle of longitudinal arch (ALA), and the amount of calcaneus axial lengthening (CAL).
RESULTS: The mean calcaneal axial lengthening was 43.8 ± 3.1 mm (range, 39-49.5 mm), and the mean proportion of the lengthened calcaneus was 47.8% ± 3.7% (range, 42.8-55.3%). The mean external fixation time was 104.8 ± 67.5 days (range, 69 to 242 days), and the mean external fixation index was 2.4 ± 1.6 days/cm. All patients stuck to the postoperative follow-up plan with an average follow-up time (FT) of 35.0 ± 6.7 months (range, 26-40 months). Deformities of the injured limbs were all corrected according to radiography. Based on the AOFAS, three excellent and three good results were achieved.
CONCLUSIONS: The Ilizarov technique remains an option for calcaneus reconstruction with a great amount of loss once combined with tarsal bone fusion. The function of the injured foot and ankle can be satisfactorily restored using these techniques in our study. Apart from calcaneus elongation, tarsal bone fusion is somehow necessary to reinforce the proximal segment of the distracted calcaneus for creating a larger distraction callus, correcting concomitant foot deformities, and enhancing hindfoot stability. It is necessary to choose flexibly when tarsal bones should be fused.