外固定架用于跟骨骨折治疗的功能结果和并发症

Outcome and Complications of Intraarticular Calcaneal Fractures with External Fixator as Indirect Reduction and Fixation

目的对外固定架用于跟骨关节内骨折中的治疗作用和并发症进行回顾性研究。方法对2000年2月～2005年8月收治的31例跟骨关节内骨折进行评估，所有患者均应用外固定架作为辅助显露、复位或固定方式。骨折分型采用RoySander关节内骨折的CT分型，功能结果采用Maryland评分标准评定。CT扫描对复位结果进行评定，X线片用于分析跟骨Bohler角和Gissane角改变。结果本组平均随访时间48个月（18～65个月）。其中Ⅱ型骨折9例、Ⅲ型骨折12例、Ⅳ型骨折10例。Maryland评分结果：优9例，良10例，一般11例，差1例。复位结果评定：优9例，良12例，一般8例，差2例。复位结果与功能结果有显著的相关性（P=0．00）。与术前比较，Gissane角术后降低有非常显著性意义（P=0．00）；Bohler角术后增大有非常显著性意义（P=0．00）。并发症包括皮肤坏死2例，深部感染2例，创伤性关节炎3例。结论外固定架辅助显露、韧带整复作用以及微创固定方式可提高跟骨关节内骨折的复位质量，有利于足部功能恢复。

Objective To evaluate the outcome and complications of the external fixator as a adjuvant device in the surgical treatment of intraarticular calcaneal fractures. Methods Thirty- one patients who had surgical treatment of intraarticular calcaneal fractures between 2000 and 2006 were evaluated. All patients were treated with the external fixator as adjuvant device in exposure, indirect reduction or terminal fixation. The Sander classification based on the computed tomography for intraarticular calcaneal fractures was adapted and Maryland foot evaluation system was used to assess functional outcome. Reduction results were evaluated by CT scan and Bohler and Gissane angle were measured pre - and post - operatively in X - ray film. Results The average follow - up was 48 months （range, 18 to 65 months）. There were 9 type Ⅱ fratures, 12 type Ⅲ fractures, 10 type Ⅳ fractures in this series. Maryland score outcome was excellent in 9 patients, good in 10, fair in 11, poor in 1 patient. Reduction was evaluated as excellent in 9 patients, good in 12, fair in 8, poor in 2 patients. There was high correlation between reduction and clinical outcome （P = 0.00）. Bohler angle was increased and Gissane angle was decreased significantly after surgical treatment （P = 0.00, P = 0.00, respectively）. There were 2 skin necrosis, 2 deep infection, 3 traumatic arthritis in our series. Conclusion The external fixator is contributed to improving the clinical outcome of the surgical treatment of calcaneal intraarticular fractures by means of adjuvant exposure, indirect reduction and mini- invasive fixation.