跟骨关节内骨折34例手术治疗及疗效观察

34 cases of operative treatment for articular fractures of the ca lcaneus and effect observation

目的探讨跟骨关节内骨折手术治疗及疗效观察。方法跟骨关节内骨折34例（46足），男29例（39足），女5例（7足）；年龄18～55岁，平均34岁；伤因：高处坠落伤27例，车祸伤7例，合并胸腰椎骨折5例，合并股骨干骨折3例，依sanders型：Ⅱ型19足，Ⅲ23足，Ⅳ型4足，均采用手术切开复位，钢板螺丝钉内固定。结果30例（42足）获得随访，随访时间6～36个月，平均18个月，所有患者在术后3—5个月骨性愈合。其中2例分别于术后10个月、12个月出现距下关节创伤性关节炎，保守治疗无效后二期行距下关切融合术，6个月和9个月后骨性融合。5例出现切口皮缘坏死，经局部换药，红外线照射，皮瓣转移治愈，Bohler角术前平均9°，术后平均31°。按MarYland足部评分系统，优19足，良22足，可4足，差1足，优良率89．1％．结论在跟骨关节骨折手术治疗中，只要严格选择手术适应证，把握合适的手术时机，提高手术技巧并加强围手术期护理就能减少并发症，提高手术的疗效；出现并发症后，可根据情况作出相应处理，能取得满意的疗效。

Objective To approach the operative treatment for articular fractures of the calcaneus and effect observation. Methods 34 cases of articular fractures of the calcaneus （46 feet）,29 cases of men and 39 feet, 5 cases of women and 7 feet; age from 18 to 55 years old, average of 34 years old. As a result of injuries： 27 cases of hurting by falling off the height, 7 Cases of hurting by car accident, the combined thoracic and lumbar fractures in 5 cases, the combined femoral shaft fractures in 3 cases, according to Sanders Type： Ⅱ 19 feet Ⅲ 23 feet, Ⅳ-4 foot, using open reduction surgery, using the screw to fixup. Results 30 cases of 42 feet was followed up for after 3 to 5 months of bone healing. 2 next joint traumatic arthritis, null 6 to 36 months, an average of 18 months in all patients cases in which after 10 months, 12 months before the and void after the conservative treatment under the second phase of spacing concern fusion, 6 months and 9 months after the bone-fusion. 5 cases of skin flap necrosis occurred incision, the dressing was changed by local, infra-red radiation, the transfer of skin healing, Bohler angle before an average of 9° ,after an average of 31° .According to the Maryland Foot Score , 19 feet were excellent, 22 feet were good, 4 feet were general, except 1 foot was not good, choiceness of 89.1 percent. Conclusion During the operative treatment for articularfractures of thecalcaneus, as long as the choice of strict indication, take appropriate the timing of surgery, the surgical techniques to enhance and strengthen the perioperative care can reduce complications and improve the efficacy of surgery; complications appeared., according to the situation to deal with accordingly. It would be able to achieve a satisfactory effect.