切开复位内固定与植骨治疗跟骨关节内移位骨折

Open reduction and internal fixation with bone grafting for treatment of calcaneal displaced intra-articular fracture

目的:评估切开复位内固定及植骨治疗跟骨关节内移位骨折的临床效果。方法:35例41足跟骨关节内移位骨折,其中男29例,女6例;年龄16-57岁,平均33.1岁;左足18例,右足11例,双足6例。X线片示:Bhler角0°-15°者19足,<0°者22足。按Sanders分类:Ⅱ型14足,Ⅲ型23足,Ⅳ型4足。并行切开复位普通跟骨接骨板内固定及植骨术。结果:41足经平均18个月随访,按Maryland足部评分系统评估手术疗效,其中优(90-100分)31足,良(75-89分)7足,可(50-74分)2足,差(<50分)1足,优良率为92.7%(38/41)。结论:跟骨关节内移位骨折行切开复位内固定术可取得良好临床疗效,植骨术有利于早期负重及避免距下关节面的塌陷。

Objective： To evaluate the clinical effect of open reduction and internal fixation with bone grafting for treating calcaneal displaced intra-articular fracture. Methods： Forty-one calcaneal displaced intra-articular fractures in 35 patients were included in this study. Among the patients,29 were male and 6 were female,and the average age was 33. 1 years （ 16 to 57）. The lesions of 18 cases were in left foot,ll in right foot,6 in both feet. The Boehler angle of 19 cases ranged 0° to 15° ,22 less than 0% Classification of calcaneus fracture was done according to Sanders＇ computed tomographic classification system. There were 14 cases of type Ⅱ fractures,23 type Ⅲ fractures and 4 type Ⅳ fractures. Open reduction and internal fixation with the ordinary blade plates for calcaneus and bone grafting were performed. Results： Forty-one cases were followed up for an average of 18 months, and the clinical results were evaluated with the Maryland foot score. Thirty-one cases achieved excellent results,7 good ,6 fair, 1 failure,with the rate of excellent and good results being 92. 7% （38/41）. Conclusion： Open reduction and internal fixation is an excellent operative method to treat the displaced intra-articular fracture of calcaneus, and the combination with bone grafting has the advantage of preventing subtalar joint collapse and early weight-bearing.