跟骨骨折的手术治疗

Surgical treatment of fracture of calcaneus

目的：探讨AO跟骨钢板治疗跟骨有移位骨折的疗效。方法：跟骨骨折73例81足,男61例,女12例;年龄18-63岁,平均41岁。双侧跟骨骨折8例,单侧65例（左侧33例,右侧32例）。按Sanders分型：Ⅱ型36例,Ⅲ型28例,Ⅳ型9例。采用AO跟骨钢板治疗,伤后1-3d手术48例,伤后4-7d手术14例,7d以上手术11例。结果：术后73例均获得随访,时间6-26个月,平均15个月。按Fernandez标准评定分为4级,优31例,良37例,可2例,差3例。本组有7例术后出现切口边缘皮肤坏死,其中5例予以择期植皮,2例局部邻近皮瓣转移覆盖治愈。结论：AO跟骨钢板根据跟骨的解剖特点和跟骨有移位骨折的特点而设计,对跟骨骨折块进行固定有较好的把持力,增强抵抗应力,防止再移位。

Objective：To explore therapeutic effect of surgical treatment of displaced calcaneal fracture treated with AO steel plate for calcaneus. Methods： Seventy-three patients （81 feet） with calcaneal fracture included 61 male and 12 female with an average age of 41 years ranging from 18 to 63 years. Eight patients were in both side of calcaneus and 65 were in simple one side（33 in left and 32 in right）. According to Sanders＇ typing,there were 36 cases of type Ⅱ ,28 of type Ⅲ ,9 of type Ⅳ. All patients were treated with AO steel plate for calcaneus form. The course before operation was 1 to 3 days in 48 cases ,4 to 7 days in 14,more than 7 days in 11. Results：All the cases were followed up for an average of 15 months,ranging from 6 to 26 months. According to Fernandez evaluation, excellent results achieved in 31 cases, good in 37, fair in 2, poor in 3. Among them, 7 cases of wound necrosis were treated with planted skin in （5 cases） and covered with adjacent flap grafts （2 cases ）. Conclusion： AO steel plate for calcaneus is design for characteristic of the anatomy, fracture and dislocation of calcaneus. It has good stability for fixation of calcaneal fracture and can reinforce counteract stress to prevent re-displacement.