改良外侧“L”切口锁定钢板固定跟骨截骨术

Calcaneal osteotomy fixed with locking plate through a modified lateral “L”-shaped incision

摘要:

[目的]介绍改良外侧“L”切口锁定钢板固定跟骨截骨术的手术技术和初步临床效果。[方法]2019 年 1 月—2021 年 10 月对 21 例患者采用改良外侧“L”切口锁定钢板固定跟骨截骨术矫正跟骨内外翻畸形。于跟骨外侧做改良的“L”切口， 切口拐角呈钝角，切口的垂直线和水平线分别位于外踝尖到跟腱外缘和跟骨下缘的 2/3。显露跟骨外侧壁，行跟骨截骨，根据需要对跟骨进行推移，恢复下肢力线。摆锯磨平推移时产生的台阶，用锁定钢板进行固定。术后石膏固定 3 周，6 周时开始下肢功能锻炼。[结果]所有患者均顺利完成手术，无严重并发症。截骨手术时间平均（15.0±2.7）min。随访时间平均（8.5±1.3） 个月，跟骨截骨临床愈合时间平均 （4.9±0.8） 周。末次随访时，AOFAS 评分较术前显著增加 [(85.2±4.6) 分 vs (34.6±7.0) 分, P＜ 0.05]，VAS 评分较术前显著减少 [(2.1±1.0) 分 vs (7.9±0.9) 分，P＜0.05]。[结论] 改良外侧“L”切口锁定钢板固定跟骨截骨术便于操作，临床效果满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical consequences of calcaneal osteotomy fixed with locking plate through a modified lateral “L”-shaped incision. [Methods] From January 2019 to October 2021, a total of 21 patients re- ceived abovementioned surgical operation for calcaneal varus and valgus deformities. The modified lateral “L”-shaped incision was made with doute turning angle parallel to the lateral malleolus and foot bottom respectively to expose the lateral well of the calcaneous. As calcane- ous osteotomy was conducted, the distal fragment of osteotomy was moved according to the need to correct the deformity, and then fixed with locking plate with trimming the step of the osteotomy site. The affected limb was immobilized with plaster cast for 3 weeks, and functional ex- ercises was encouraged 6 weeks postoperatively. [Results] All patients had operation performed successfully without serious complications, whereas with time of osteotomy range from 10 min to 19 min, with an average of (15.0±2.7) min. All the patients were followed up for 6~10 months, with an average of (8.5±1.3) months, and got osteotomy clinical healing 4~6 weeks, with an average of (4.9±0.8) weeks postoperative- ly. The AOFAS score increased significantly from (34.6±7.0) preoperatively to (85.2±4.6) at the latest follow-up (P＜0.05), while the VAS score decreased significantly from (7.9±0.9) preoperatively to (2.1±1.0) at the last follow-up (P＜0.05). [Conclusion] The modified lateral “L” incision with locking plate fixation for calcaneal osteotomy is easy to perform, and achieve satisfactory clinical outcome.