跟骨骨折切开复位内固定术后疗效及切口并发症分析

Analysis of Therapeutic Effects and Wound Complications Following Open Reduction and Internal Fixation of Calcaneal Fractures

目的探讨跟骨关节内骨折切开复位钢板内固定手术治疗的疗效及早期手术切口的并发症。方法采用跟骨外侧延长"L"形切口入路对50例57足跟骨关节内骨折进行切开复位钢板内固定治疗。按Essex-Lopresti进行骨折分类,舌型骨折30足,关节压缩型骨折27足。根据手术前后X线片对跟骨高度、宽度、长度及跟骨B hler角和Gissane角进行评估,并观察术后切口愈合情况。采用Maryland足评分系统评价临床功能疗效。结果所有患者术后获得5～36个月(平均18个月)随访,X线片显示术后跟骨高度、宽度、长度及跟骨B hler角和Gissane角均获得满意恢复,Maryland足部评分系统显示优31足,良20足,可6足,优良率89.5%。术后早期出现切口裂开、坏死及感染共10例,占总病例数17.5%。结论采用跟骨外侧延长"L"形入路切开复位钢板内固定是治疗跟骨关节内骨折的有效方法,但术后早期切口并发症仍难以完全避免。

Objective To explore the clinical therapeutic effects and wound complications following open reduction and internal fixation （ORIF） of displaced intra - articular calcaneal fractures. Methods Fifty- seven intra- articular calcaneal fractures in 50 patients were treated with ORIF via extensile L- shaped lateral approach to the calcaneus under the monitoring of C - shaped arms. There were 30 tongue- type fractures and 27 joint - depression fractures according to Essex - Lopresti classification. Pre- and post - operative radio- graphs were evaluated to detect calcaneal anatomical parameters including height, width, length, B6hler angle and Gissane angle. The lateral wound healing was observed and clinical functional outcomes were graded using the Maryland foot score. Results All patients were followed up for an average of 18 months （range, 5 to 36 months）. Lateral roentgenograms showed satisfactory restoration of the caicaneal height, width, length, Bohler angle and Gissane angle. Maryland foot score demonstrated excellent results in 31 feet, good in 20, fair in 6. The excellent and good rate was 89.5 % . Wound complications were found in 10 fractured feet （17.5 % ）. Conclusion ORIF via extensile L - shaped lateral approach to the calcaneus is effective for the treatment of displaced intra - articular calcaneal fractures. However, the early wound healing complications might not be avoided completely.