踵骨骨折後遺症に対する治療経験

Surgical Treatment of Complications after a Fracture of Calcaneus

　踵骨骨折後遺障害に対して距骨下関節デブリドマン，踵骨外側壁切除を行い良好な治療成績が得られた1例を経験した．症例は58歳の男性で，左踵骨骨折に対して保存療法を受けるも踵部痛が約1年5カ月間持続した．診察上，踵骨外側壁の膨隆と距骨下関節の疼痛を認めた．後距踵関節ブロックを行ったところ一時的であるが著効した．手術は距骨下関節鏡視下デブリドマンと踵骨外側壁切除を行った．距骨下関節には瘢痕様の組織が存在し，これを切除した．術後早期から疼痛は著明に軽減し，患者満足度も非常に高かった．

　Persistent heel pain is a common complication of calcaneal fractures.　This report describes the surgical treatment of complications of a calcaneal fracture.　A 58-year-old male with a left intra-articular calcaneal fracture that had been treated non-surgically complained of persistent left heel pain.　Physical examination revealed expansion of the lateral calcaneal wall and subtalar stiffness, and the injection of a local anesthetic in the subtalar joint spale temporarily relieved the pain.　Arthroscopic debridement and resection of the expansion of the lateral wall were performed, and the sinus tarsi and posterior talocalcaneal facet were debrided of scar-like fibrous tissue.　The arthroscopic debridement dramatically relieved the pain , and the patient was greatly satisfied with the results.　The score on the JSSF scale improved from 69 points to 89 points.　Arthroscopic debridement is therefore concluded to be useful in the treatment of complications of a fracture of the calcaneus primarily caused by the presence of scar-like fibrous tissue in the sabtalar joint.