跟骨关节内骨折的钢板内固定治疗疗效及并发症分析

Plate fixation treatment for intra articular calcaneal fractures:results and complications

目的分析跟骨关节内骨折切开复位内固定治疗的疗效及并发症。方法自1998年1月～2004年10月,收治跟骨关节内骨折患者共31例(36侧)。Sanders分类Ⅱ型2侧,Ⅲ型22侧,Ⅳ型12侧。采用跟骨外侧入路,钢板内固定及植骨治疗,对术前、术后数据统计分析。结果随访6～33个月,平均25个月,术后3个月骨折全部愈合。术前平均Bhler角13.2°,Gissane角75°,距下关节面最大垂直移位5.0mm;术后Bhler角38.5°,Gissane角115.5°,距下关节面最大垂直移位0.3mm,手术前、后有统计学显著性差异(P<0.01)。术后皮瓣坏死5例,腓骨肌腱炎3例,距下关节炎4例。采用Maryland评分平均83.6分,优良率83.3%。结论切开复位钢板内固定治疗跟骨关节内移位骨折是一个较好的方法,尤其适宜SandersⅢ型、Ⅳ型,临床效果满意,但围手术期需注意预防并发症。

Objective To analyze the results and complications of the treatment of intra articular calcaneal fractures with internal plate fixation. Methods From January 1998 to October 2004, 31 patients with calcaneal fracture (36 calcanea) were treated in our hospital. According to Sanders classification, there were 2 type Ⅱ,22 type Ⅲ,and 12 type Ⅳ. They were treated with reconstruction of the joint surface, internal fixation with screw and plate through the extensile lateral approach, and bone graft. The preoperative and postoperative data were statistically analyzed with SPSS 10.0. Results Follow ups lasted from 6 to 33 months with an average of 25 months. All the fractures healed 3 months after operation. On average, Bhlers angle was improved from preoperative 13.2°to postoperative 38.5°, Gissanes angle from 75°to 115.5°, and step distance from 5.0mm to 0.3mm. The differences between the preoperative and postoperative data were statistically significant(P< 0.01). 4 cases of arthritis of the subtalar joint, 3 cases of peroneal tendonitis and 5 cases of flap necrosis were found. Maryland scoring system was used to evaluate the postoperative results. The excellent and good rate was 83.3%. Conclusion Open reduction and internal fixation is a good method to treat the displaced intra articular calcaneal fractures, especially those of Sander types Ⅲand Ⅳ, but care should be taken to prevent complications during perioperative period.