陈旧性跟骨骨折的手术治疗.ppt

2009SynthesFoot&AnkleSeminar,陈旧性跟骨骨折的手术治疗,同济大学附属同济医院骨科俞光荣,2009SynthesFoot&AnkleSeminar,跟骨骨折畸形愈合的病理学基础,2009SynthesFoot&AnkleSeminar,跟骨丘部平坦或消失距下关节不平整后跟增宽穿鞋困难跟腓撞击及前胫距撞击跟腱短缩、小腿三头肌肌力下降距下关节或跟骰关节创伤性关节炎后足力线异常距骨倾斜角缩小或消失致胫距撞击关节面硬化或后关节面缺血性坏死腓骨肌腱脱位创伤性扁平足（后足、中足、动力性）后足的内外翻（主要为跟骨）,踝痛,膝痛,髋痛,下腰背痛,颈和头痛,2009SynthesFoot&AnkleSeminar,陈旧性跟骨骨折至今没有理想、公认的分类,2009SynthesFoot&AnkleSeminar,Stephens和Sanders的CT分型,型畸形愈合：跟骨外侧外膨，有或没有极外侧的局限性距下关节炎型畸形愈合：跟骨外侧外膨，伴有广泛的距下关节炎型畸形愈合：跟骨外侧外膨，伴有广泛、严重的距下关节炎，跟骨体畸形愈合伴有后足内翻或外翻成角畸形,2009SynthesFoot&AnkleSeminar,Stephens、Sanders分型,2009SynthesFoot&AnkleSeminar,Zwipp陈旧性跟骨骨折分类,2009SynthesFoot&AnkleSeminar,型骨折:关节活动不协调，有关节炎表现,2009SynthesFoot&AnkleSeminar,采用原位单纯距下关节融合术,2009SynthesFoot&AnkleSeminar,型骨折：伴有后足的内外翻畸形,2009SynthesFoot&AnkleSeminar,距下关节融合植骨纠正畸形,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,型骨折：伴有足高度丢失，负Bhler角,2009SynthesFoot&AnkleSeminar,距下关节融合截骨纠正畸形,2009SynthesFoot&AnkleSeminar,骨折：伴有跟骨平行移位,2009SynthesFoot&AnkleSeminar,距下关节融合截骨纠正畸形,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,型骨折：伴有距骨倾斜,2009SynthesFoot&AnkleSeminar,距下关节融合截骨纠正畸形,2009SynthesFoot&AnkleSeminar,单、三关节融合术,主要指征严重畸形愈合涉及距下和跟骰关节关节,2009SynthesFoot&AnkleSeminar,切开复位内固定,2009SynthesFoot&AnkleSeminar,适应证,骨折时间在伤后6周之内软组织条件较好距下关节和跟骰关节破坏不严重,2009SynthesFoot&AnkleSeminar,男性，42岁，跟骨骨折后5周,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,跟骨丘部重建、距下关节融合,2009SynthesFoot&AnkleSeminar,主要适应征与禁忌征,适应证各种类型后关节面塌陷畸形愈合的严重陈旧性跟骨骨折有严重跟骨轴成角畸形禁忌证局部有感染或血管性疾病有严重重要脏器病变或代谢性疾病,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,2009SynthesFoot&AnkleSeminar,保留距下关节的跟骨截骨矫形,2009SynthesFoot&AnkleSeminar,距下关节对维护足踝功能的重要性,对踝关节冠状面运动具有重要的缓冲作用维护后足各关节的正常活动范围距下关节具有承重及三维活动功能主要完成后足的内外翻功能，以能够完成跑、跳、爬及适应高低不平路面行走等活动活动范围改变将导致步态异常、活动受限、足部畸形，及整个下肢或下腰椎的病理改变,2009SynthesFoot&AnkleSeminar,单纯距下关节融合后距舟关节的活动度背、跖屈减少56距下关节对距舟关节功能的正常发挥具有重要意义足内、外翻减少70,2009SynthesFoot&AnkleSeminar,手术指征和禁忌征,手术指征年龄较轻，骨折畸形不很严重，受伤后时间在9个月内舌型骨折块和后关节面压缩骨折块外形可见手术禁忌征同其它跟骨骨折手术严重粉碎性、畸形愈合的跟骨骨折舌型骨折块和后关节面压缩骨折块外形模糊,2009Synthe