切开复位内固定治疗移位的跟骨关节内骨折的疗效分析

Open reduction and internal fixation for displaced intra-articular calcaneal fractures

目的评定切开复位内固定治疗移位的跟骨关节内骨折的疗效，并分析其影响因素。方法回顾性分析2004年3月至2006年7月收治的采用切开复位内固定治疗的移位跟骨关节内骨折40例（46足），按照Sanders分型：Ⅱ型16足，Ⅲ型19足，Ⅳ型11足，总结评定其临床疗效并分析影响疗效的相关因素。结果所有患者均得到随访，平均随访18个月（13～28个月）。根据Maryland足部评分系统评价术后疗效：优21足，良16足，可6足，差3足，优良率82．6％。优良率在不同骨折类型中分别为：Ⅱ型93．8％（15／16），Ⅲ型84．2％（16／19），Ⅳ型54．5％（6／11）；伤后至手术时间≤14d组和〉14d组分别为87．2％（34／38）和42．9％（3／8）；在术后Bnhler角〈15°组和≥15°组分别为37．5％（2／9）和89．5％（35／37）；关节面复位质量≤2mm组和〉2mm组分别为91．2％（32／33）和45．5％（5／13）。对各因素的优良率比较，差异有统计学意义（P〈0．05）。结论切开复位内固定治疗移位的跟骨关节内骨折，治疗效果好。骨折类型、伤后至手术时间、术后Bohler角的恢复程度、关节内骨折的复位质量为影响其术后疗效的重要因素。

Objective To evaluate open reduction and internal fixation for displaced intra-articular calcaneal fractures and analyze factors affecting its clinical results. Methods From March 2004 to July 2006, 46 displaced intra-articular calcaneal fractures in 40 patients were surgically treated by open reduction and internal fixation. According to Sanders classification, there were 16 cases of type Ⅱ, 19 cases of type Ⅲ and 11 cases of type IV. Results All the patients were followed up for an average of 18 （13 to 28） months. The effects of treatment were evaluated according to Maryland Foot Score： excellent in 21 feet, good in 16 feet, fair in 6 feet, poor in 3 feet. The total good to excellent rate was 82. 6%. The respective good to excellent rates were 93. 8% for type Ⅱ fractures, 84.2% for type Ⅲ, and 54.5% for type Ⅳ; 87.2% for the group with time interval from injury to surgery ≤ 14d, and42. 9% for the group with time interval 〉 14 d; 37.5% for the groupwith Bshler angle 〈 15° and 89.5% for the group with Bohler angle ≥ 15°; 91.2% for the group with reduction of intra-articular calcaneal fractures ≤2 mm, and 45.5% for the group with the reduction 〉 2 mm. The differences within each factor group were statistically significant （ P 〈 0.05） . Condnsions Open reduction and internal fixation for displaced intra-articular calcaneal fractures is a good method. Fracture type, time interval from injury to surgery, BShler angle reduction, reduction ofintra-articular calcaneal fractures are important factors affecting outcome of operation.