摘要
目的探讨可塑性钛板在跟骨关节内骨折中的应用价值。方法采用关节内骨折切开复位可塑性钛板内固定治疗42例(49足)跟骨关节内骨折,其中SandersⅡ型11足,Ⅲ型23足,Ⅳ型15足。术后进行3~36个月随访,观察患足功能恢复情况及评定临床疗效。结果出现切口皮缘部分坏死4例,足外缘皮肤感觉麻木2例,骨折复位不佳者2例。与术前相比,术后跟骨侧轴位X线片显示跟骨Bohler角、Gissane角及距下后关节面均得到了良好的恢复(P<0.001)。按照Kerr评定标准,临床疗效平均优良率为81.63%,SandersⅡ型、Ⅲ型和Ⅳ型优良率分别为90.91%、86.96%和66.67%,三种类型优良率呈下降趋势,但组间差异均无统计学意义(P>0.05)。结论切开复位可塑性钛板内固定是治疗跟骨关节内骨折的可靠方法。恢复跟骨解剖形态、掌握好手术指征和手术时机、选择合适的可塑性钛板固定能最大限度地减少骨折后并发症。
Objective To investigate the application value of plastic titanic plate for intra - articular fracture of calcaneus. Methods Forty- two patients (49 feet) with intra- articular calcaneal fracture were treated with open reduction and internal fixation with plastic titanic plate. According to Roy sanders classification, 11feet were classified as Sanders type Ⅱ , 23 feet as type Ⅲ , and 15 feet as type Ⅳ. They were followed up for 3--36 months, and the status of feet functional rehabilitation was observed and the treatment effects were evaluated. Results After follow- up, 4 patients were found with parts of skin margin necrosis, 2 with feet margin cutaneous sensation anesthesia, 2 with fracture reset not excellent. Compared with the preoperative group, in the postoperative group at calcaneal bone rachlet view, X - ray films showed that Bohler angle, Gissane angle and below and posterior articular facet of calcaneal bone were recovered significantly satisfactorily (P 〈 0.001). According to Kerr evaluation standards, the mean good and excellent rate was 81.63 %. The good and excellent rates of Sanders typeⅡ , type Ⅲ and type IV were 90.91%, 86.96% and 66.67%, respectively. There was de- creasing tendency of the good and excellent rates in three types groups. But there was no statistical significance between the three groups (P 〉 0.05). Conclusion The open reduction and internal fixation with plastic titanic plate is reliable to treat intra - articular caleaneus fractures. Restoring the articular anatomy, mastering well operation indication and opportunity and choosing the appropriate plastic titanic blare internal fixation can greatly decrease complications of calcaneal fracture.
出处
《中国骨与关节损伤杂志》
2008年第5期386-388,共3页
Chinese Journal of Bone and Joint Injury
关键词
跟骨
关节内骨折
可塑性钛板
外科治疗
Calcaneus
Intra - articular fracture
Plastic titanic plate
Surgical treatment