Хірургічне лікування внутрішньосуглобових переломів п'яткової кістки

Abstract

Представлены оригинальный аппарат для чрескостного остеосинтеза и техника его применения при внутрисуставных переломах пяточной кости. С 2017 г. в клинике по разработанной методике аппарат был использован в лечении 11 больных (средний возраст – 35,8 лет). У всех пострадавших повреждения были внутрисуставными: язычковые переломы отмечены в 4 случаях, импрессионые – в 5, раздробленные – в 3. Аппарат позволяет выполнить управляемую репозицию и стабильную фиксацию отломков пяточной кости до сращения, сохраняя при этом функцию голеностопного и подтаранного суставов. Результаты хирургического лечения прослежены у 9 пациентов в среднем через 10,7 мес. после операции. Оценка результатов восстановления анатомии и функции стопы показала, что оперативное лечение переломов пяточной кости разработанным устройством приводит к лучшим как среднесрочным, так и долгосрочным результатам – (88,70±5,09) балла по шкале Американского ортопедического общества стопы и голеностопного сустава.

Despite the constant improvement of the surgical equipment and various fixators, intra-articular fractures of the calcaneus remain difficult for surgical treatment. Discussions about which method of treatment of these fractures is optimal, continue to the present time. In order to improve the results of treatment of patients with injuries of the calcaneus, a device for transosseous osteosynthesis has been developed, which allows to restore its anatomy after fractures. The article presents the technique of using the original apparatus for transosseous osteosynthesis in intra-articular fractures of the calcaneus. Since 2017, it has been used in the treatment of 11 patients aged 25 to 58 (average age – 35.8) according to the developed method in the clinic. All the injuries were intra-articular: lingular fractures were noted in 4 cases, depressed – in 5, comminuted – in 3. Operations were performed within 2 days to 2 weeks after the injury. The device allows to make a controlled reposition and stable fixation of fragments of the heel bone till union, maintaining the function of the talocrural and the subtalar joints. The results of the surgical treatment were observed in 9 patients on average in 10.7 months after the surgery. The evaluation of the results was carried out on the basis of indicators of recovery of the anatomy and function of the foot, the radiological results of the subtalar joint recovery ratios were determined by lateral, axial and oblique projections. The osteoarthritis changes were taken into account with the help of computed tomography. We have revealed significantly better clinical results in the dynamics of pain, functional activity, range of motion and trophic disorders of the posterior foot. The control roentgenograms under load in all the operated patients showed the restoration of the talus-heel correspondence, the average Bohler angle was (27.5±3.4)°, no signs of osteoarthritis changes in the subtalar joint were observed. The evaluation of the results of restoration of the anatomy and function of the foot showed that the surgical treatment of the fractures of the heel bone by the developed device leads to the best both medium and long-term results (88.70±5.09 points on American Orthopaedic Food and Ankle Society Scale).