外侧延长入路和切开复位内固定治疗跟骨关节内骨折

Treatment of displaced intra-articular calcaneus fractures using the extensile lateral approach and internal fixation

[目的]本研究期望通过自己的临床治疗来评价用外侧延长入路，行切开复位内固定术治疗跟骨关节内骨折。[方法]在2001—2005年间，用外侧延长入路和切开复位内固定治疗移位的跟骨关节内骨折35人41足，25右足16左足。其中40例采用钢板内固定，1例为螺钉。[结果]术后X线片评价：90％（37／41）达到解剖复位，73％（30／41）Bohler角恢复达到20°以上。35例病人中28人共32足获得随访，平均随访14个月，平均恢复正常生活时间为4个月。采用AOFAS后足和踝关节评分系统评估，平均得分为87分，无一神经损伤，但有4例患者伤口皮瓣血肿，并且其中2例病人的伤口部分坏死，换药后1个月均愈合，没有采用皮瓣转移。值得一提的是：这2例病例都是早期手术病例。[结论]外侧延长入路和切开复位内固定治疗跟骨关节内骨折能直视下纠正跟骨骨折的病理改变，关节面的解剖复位和整个跟骨外形的恢复对预后可产生较大影响。

[ Objective] To evaluate our protocol with the extensile lateral approach to open reduction and internal fixation in the treatment of displaced intra-articular calcaneus fractures. [ Method ] From 2001 to 2005, 35 patients （41 leers）were treated with open reduction and internal fixation using extensile lateral approach, with 25 fight feet and 16 left feet and with plate fixation using in 40 eases, single screw fixation using in 1 case. [ Result]Evaluated with postoperative plain radiographs, 90% （37/41） fracture had anatomic or near anatomic reduction of posterior facet. 73% （30/41） Bohler angle above than 20° in 28 cases, 32 feets among the patients were followed up at a mean of 14 months （ ranged, 9 to 24 mouths ） and evaluated according to hind foot and ankle score system of AOFAS, average score was 87. The function were satisfactory. It took average 4 month to come back normal action, none of nerves injury, 4 patients had wound hematoma. Two cases developed surgical wound edge necrosis and dehiscence among them, who were treated in initial phase in the treat group, the 2 cases were managed with dressing changes and healed in 1 month, whitout skin flaps and grafts. [ Conclusion] Open reduction and internal fixation using lateral approach is a better choice to treat intra-articular calcaneal fractures,because it can correct directly the pathology of calcaneal fractures. Anatomical reduction of joint congruity and the shape of the calcaneus are important prognostic factors.