手术治疗有移位的跟骨关节内骨折

Operative management of displaced intra-articular fracture of calcaneus

目的评价手术开放复位、钢板和螺钉内固定治疗跟骨关节内骨折的疗效.方法63例71侧有移位的跟骨关节内骨折,其中SandersⅡ型18侧(25.4%),Ⅲ型26侧(36.6%),Ⅳ型27侧(38.0%).采用外侧可延伸的'L'型切口入路,开放复位、钢板和螺钉内固定.部分Ⅳ型骨折采用骨移植且术后予以石膏短期外固定.结果63例均获随访,时间6～26个月,平均15.9个月.按AOFAS标准评价功能,优29侧,良26侧,可11侧,差5侧,优良率77.6%.结论有移位的跟骨关节内骨折,切开复位,钢板、螺钉内固定治疗可获得满意的效果,但Ⅳ型跟骨关节内骨折的治疗效果较Ⅱ、Ⅲ型差.

Objective To assess the outcome of open reduction and plate fixation for displaced intra-articular fractures of calcaneus. Methods 63 patients with 71 cases of displaced intra-articular calcaneal fractures were enrolled.According to Sanders classification, there were type Ⅱ:18 cases(25.4%), type Ⅲ: 26 cases(36.6%); and type Ⅳ:27 cases(38.0%). The treatment was consisted of open reduction and internal fixation with plate and screws through an extensible, L-shaped lateral approach. Bone grafting and short-term plaster immobilization were performed in some type Ⅳ fractures. Results All cases were followed up for 6～26 months, 15.9 on average. According to the AOFAS Ankle-Hindfoot scores, the results were excellent in 29 cases,good in 26, fair in 11, and poor in 5, and the excellent and good rate was 77.6%. Conclusions Satisfactory outcome can be expected with open reduction and interal fixation with plate and screws for displaced intra-articular calcaneal fractures. In type Ⅳ fractures, the result is not as good so that of type Ⅱ and type Ⅲ.