可注射硫酸钙植入治疗跟骨关节内骨折

Injectable calcium sulfate bone graft and internal fixation in the treatment of intraarticular calcaneal fracture

目的:通过观察可注射硫酸钙植入治疗累及距下关节跟骨骨折的临床预后,探讨该手术适应证及其优点。方法:选取2001-06/2006-01上海中医药大学附属普陀医院骨科收治的29例累及距下关节的严重跟骨关节内粉碎性骨折患者作为实验对象。采用连续硬膜外麻醉,手术切口采用跟骨外侧“L”切口,分别切开皮肤、深筋膜,注意防止损伤腓肠外侧皮神经。采取跟骨外侧手术入路,对跟骨骨折移位行撬拨复位后植入可注射硫酸钙骨替代物,再予跟骨解剖钢板内固定。结果:29例累及距下关节的严重跟骨关节内粉碎性骨折患者均获得12个月随访。①术后患者足部疼痛、足行走功能、足跟部畸形矫正评估结果:29例患者中,优15例,良11例,差3例,优良率达89.7%。②手术前后相关指标测量结果的比较:与术前比较,术后Bihler角、Gissane角、跟骨轴长、丘部跟骨高度、跟骨水平长度及结节部高度均明显增加(P<0.05),跟骨宽度明显减小(P<0.05)。③累及距下关节的跟骨骨折手术前后X线片对比:术前跟骨粉碎性骨折,骨折累及距下关节面,跟骨短缩、增宽畸形;术中对距下关节面进行撬拨复位,关节面近似平整,采用可注射硫酸钙骨替代物植入充填,随后采用可塑性跟骨钛合金钢板内固定,术后3个月跟骨长度、宽度以及丘部高度基本恢复正常。结论:可注射硫酸钙植入+内固定术是治疗累及距下关节跟骨骨折的一种有效方法,能恢复后足外形及功能,缓解后足疼痛,促进跟骨骨折愈合。

AIM： To evaluate the clinical prognosis of intraarticular ealeaneal fracture treated by injectable calcium sulfate （CS） bone graft （BG） and internal fixation （IF）, and discuss the indications and the advantages of the management. METHODS： Totally 29 patients with severe intraartieular calcaneal splintered fractures in subtalar joint treated at Department of Orthopedics, Affiliated Putuo Hospital of Shanghai University of Traditional Chinese Medicine from June 2001 to January 2006 were adopted. The L-shaped lateral approach to calcaneus was used after continuous epidural anesthesia, then open reduction was performed in avoidance of damaging lateral sural cutaneous nerve. And the injectable CS BG material was implanted into the compression defect of calcaneal fractures, followed by ealcaneal dissected steel IF. RESULTS： All 29 cases were followed up on an average of 12 months.（1） Evaluations of postoperative patients in feet pain, feet walking function and deformity correction of heels： The effect was excellent in 15 cases, good in 11 cases and weak in 3 cases, With 89.7% rate of good and excellent effects. （2） Comparison of related index measurements before and after operation： Boehler angle, Gissane angle, length of calcaneal axis, cumulus calcaneal height, aclinic length of calcaneal and height in pars tuberalis were obviously enhanced after operation （P 〈 0.05）, but calcaneal width was obviously reduced compared with that before operation （P 〈 0.05）.（3） Comparison of X ray before and after operation： Before operation, calcaneal splintered fracture was involved in subtalar articular surface, accompanying with caleaneal deformity of shortening or extending; During the operation, subtalar articular surface was proximately plain after reduction, and implanted with injectable CS BG material, then fixed internally with plasticit steel. Moreover, the length and width of calcaneus together with the cumulus height were recovered to normal after postoperative 3 months. CONCLUSION： The combination of injectable CS BG and IF is effective for treating intraarticular calcaneal fractures. It may recover hindfoot shape and function, relieve hindfoot pain and promote the healing of calcaneal fracture.