Design of subtalar joint fusion plate and its application
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摘要:目的
设计一种带有距下关节加压融合功能的新型跟骨接骨板，评价其应用于SandersⅣ型跟骨骨折的临床疗效。
方法使用自行设计的距下关节融合板对50例需要一期融合距下关节的SandersⅣ型跟骨骨折患者进行内固定治疗，观察患者术前、术后和末次随访时的Bolher角、Gissane角以评估跟骨解剖形态，并采用美国足踝外科协会(AOFAS)踝-后足评分评估术后功能。
结果50例患者均顺利完成手术，手术时间37~72 min, 平均(48.04±9.32) min, 术中出血量90~140 mL, 平均(106.00±12.04) mL, 术中均无重要神经、血管损伤; 50例患者均获得随访，随访时间12~21个月，平均(16.36±2.24)个月; 50例患者末次随访时均达到骨性愈合，骨性愈合时间为8~14周，平均(9.52±1.25)周。术后、末次随访时，患者Bolher角、Gissane角均大于术前，差异有统计学意义(P < 0.001); 患者术后Bolher角、Gissane角与末次随访时比较，差异无统计学意义(P=0.372、0.140)。末次随访时，患者平均AOFAS踝-后足评分为(83.78±5.61)分，优9足(90~100分)、良39足(75~ < 90分)、可2足(50~ < 75分)，优良率为96.00%; 3例患者术后出现切口皮缘坏死，经过多次换药后切口愈合。
结论距下关节融合板设计合理，可以提供坚强、牢固的固定，术中骨折复位满意，手术操作简单，是治疗需要一期融合距下关节的SandersⅣ型跟骨骨折的理想内固定材料。
Abstract:ObjectiveTo design a new calcaneal plate with function of subtalar joint compression fusion, and to evaluate its clinical effect for Sanders type Ⅳ calcaneal fracture.
MethodsA total of 50 cases with Sanders type Ⅳ calcaneal fracture requiring primary subtalar joint fusion were treated with internal fixation using a self-designed subtalar joint fusion plate. The anatomical morphology of the calcaneus was evaluated by observing Bolher Angle and Gissane Angle before operation, after operation and at the last follow-up, and the postoperative function was evaluated by the American Association of Foot and Ankle Surgery (AOFAS) ankle-posterior foot score.
ResultsAll 50 patients completed operations successfully, the operation time was from 37 to 72 min, with an average of (48.04±9.32) min, intraoperative bleeding volume was from 90 to 140 mL, with an average of (106.00±12.04) mL. There was no significant nerve and vascular injury during operation. All 50 patients were followed up, with follow-up time of 12 to 21 months and an average of (16.36±2.24) months. Bone healing was achieved at the last follow-up in all 50 patients, and the healing time was 8 to 14 weeks, with an average of (9.52±1.25) weeks. The postoperative and final follow-up Bolher angles were significantly larger compared with that before surgery (P < 0.001), while there were no statistically significant differences in Bolher angle and Gissane angle between postoperative and final follow-up (P=0.372, 0.140). AOFAS score at the last follow-up was (83.78±5.61), including 9 feet with excellent rating (score of 90 to 100), 39 feet with fine rating (score of 75 to less than 90), and 2 feet with good rating(score of 50 to less than 75), with an excellent and good rate of 96.00%. Postoperative skin edge necrosis occurred in 3 patients, and wound healed after multiple dressing changes.
ConclusionThe subtalar joint fusion plate is reasonable in designand can provide ]strong and firm fixation, with satisfactory intraoperative fracture reductionand simple operation. It is an ideal internal fixation material for Sanders type Ⅳ calcaneal fracture requiring primary subtalar joint fusion.
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Keywords:
- calcaneal fracture /
- subtalar joint /
- joint fusion /
- innovative type /
- calcaneal locking plate
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图 2 典型病例的影像学检查结果及手术过程图
A: 术前右足CT横断位图像; B: 术前右足CT冠状位图像; C: 术前右足CT矢状位图像; D: 术中通过锁定孔固定跟骨; E: 术中通过加压融合孔打入2枚克氏针定位; F: 术中沿克氏针拧入2枚半螺纹空心螺钉，加压融合距下关节; G: 末次随访时跟骨侧位片; H: 末次随访时跟骨轴位片。
表 1 150例患者不同时点影像学指标比较(x±s)
° 指标 术前 术后 末次随访 Bolher角 12.57±2.24 31.99±4.19* 32.17±3.54*** Gissane角 88.46±6.46 129.49±5.92* 129.85±5.44*** 与术前比较, * * * P < 0.001。 
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