跟骨关节内骨折520例治疗回顾性分析

Retrospective analysis for the treatment of 520 cases of calcaneal intraarticular fracture

目的总结跟骨关节内骨折的治疗经验,探讨跟骨关节内骨折治疗方法的选择。方法回顾治疗跟骨关节内骨折520例587足,男436例492足,女84例95足,其中双足跟骨骨折67例。根据CT采用Sander’s分类法,Ⅱ型193足,Ⅲ型282足,Ⅳ型112足。撬拨复位斯氏针内固定132足,L型切口AO钢板内固定203足;微创钢板螺栓加压内固定210足。距下关节融合42足。踝关节功能根据马里兰足部评分系统术后6个月评价。结果随诊7～78个月,平均25个月,撬拨复位斯氏针内固定优良率为78%(103/132),L型切口AO钢板内固定为81.2%(165/203);微创钢板螺栓加压内固定为92.3%(194/210)。距下关节融合88.1%。结论手术治疗是跟骨关节内骨折的首选方法;采用何种手术方法要根据骨折类型、足部软组织条件和患者全身情况来决定。严格掌握手术适应证,微创手术操作,适时进行康复锻炼是治疗成功的关键。

Objective To summarize the expericece of diagnosis and treatment for calcaneal intraarticular fracture in order to select right treatment way. Methods 520 patients with calcaneal fractures were involved in this study, which included 436 male patients （492 feet） and 84 female patients （95 feet） in whom 67 eases were both calcaneus fractures. According to Sander＇s classification based on CT examination result, there were type Ⅱ calcaneal fractures （193 feet）, type Ⅲ （282 feet） and type Ⅳ （112 feet）. Among the 587 feet of calcaneal fractures, 132 feet were treated by percutaneous reduction by leverage with Kirschner＇ s wires, 203 feet were treated with AO plate with extended lateral approach （L-incision）, 210 feet were treated with self-made calcaneal anatotnical plate and screw with minimal invasive technique in the lateral of calcaneus, and 42 feet were treated by subtalar joint arthrodesis. The joint function was evaluated according to Maryland foot score system 6 months after operation. Results All the patients were followed up for 7 to 78 months（mean 25 months） .The rates of excellent and good results were 78% in the cases treated by percntaneous reduction by leverage with Kirschner＇ s wires; 81.2% in the cases treated by AO plate with extended lateral approach （L-incision）; 92.3% in the cases treated with self-made calcaneal anatomical plate and screw with minimal invasive technique and small incision （2 - 3 cm） in the lateral of calcaneus, 88.1% in the cases treated by subtalar joint arthrodesis. Conclusion The open reduction and internal fixation is the first treatment way that should be considered for the calcaneal inwaarticular fracture, s. What kind of operation methods adopted to treat calcaneal fracture should be according to the issues such types of fracture, calcaneal coverage of soft tissue and patients＇ condition. It is critical tO the fine outcome of fracture that the operation is carried out according to the indictions of treatment strictly combined with minimal invasive procedure and suitable exercise of rehabilitation at the right moment after operation.