踵骨関節内骨折に対する観血的治療法の検討

Surgical Treatment of Intra-Articular Calcaneal Fractures

　抄録：われわれは踵骨関節内骨折に対する観血的治療法の治療成績と適応を検討した．術式はWesthues変法に準じ経皮的に関節面の整復後，距骨下関節面に約3cmの小切開を加え，骨欠損部に対して人工骨を充填し，主にK-wireにて固定する小切開法と外側拡大L字型皮切で展開し主にプレート固定する観血的整復固定法である．術後臨床評価はgood以上が84％と良好な成績であった．また，術後後距踵関節面のstep offと臨床評価との相関性を認めた．小切開法施行例は全例excellentであり，高齢者，内反，関節面の陥凹の強くない症例に対しては，本法による低侵襲手術に努めるべきである．

　We investigated the results of invasive treatment of intra-articular calcaneal fractures and the indications. The surgical procedures were performed according to the modified Westhues method. One group of patients was treated by a minimally invasive procedure in which percutaneous reduction of the articular face was followed by a small incision approximetely 3 cm below the posterior talocalcaneal joint face, the bone-deficient site was filled with artificial bone, and fixation was performed mainly with K-wires. The other group of patients was treated by open reduction by an extended lateral approach through an L-shaped skin incision, and fixation was mainly performed with a plate. The results of the postoperative clinical evaluation were favorable, with a grade of “good” or better having been achieved in 84％ of the cases. In our case, no correlations were found between the postoperative Böhler's angle or calcaneal width index and the result of the clinical evaluation, but, a correlation was found between the step-off of the postoperative posterior talocalcaneal joint face and the result of the clinical evaluation. An excellent outcome was obtained in all cases in which the minimally invasive procedure was used. Whenever possible, a less invasive surgical procedures should be used in elderly patients and patients with minor depression of the joint face or inversion.