延期切开复位治疗跟骨骨折

Clinical Evaluation of Delayed Open Reduction and Internal Fixation for Calcaneal Fracture

目的 讨论延期切开复位内固定治疗跟骨骨折的临床疗效。方法 本组35例41足跟骨骨折，均先采用石膏、绷带等行骨折临时固定，待伤后1～2周，平均10．5d，局部软组织损伤恢复后再行切开复位钢板内固定。其中男性23例，女性12例；年龄16～58岁，平均36．7岁。41例骨折按照Sanders分型：Ⅱ型11例，Ⅲ型20例，Ⅳ型10例。从关节功能和影像学两方面进行疗效评价。结果 术后按Maryland评分评价术后功能。全部病例获得随访，随访时间0．5～3年，平均随访时间1．5年。按美国足踝骨科协会足踝临床评分系统评价术后功能。优14例，良20例，可5例，差2例，优良率82．9％。术后切口愈合不良6例，占随访病例的14．6％，其中皮缘小范围坏死3例、皮缘部分坏死伴浅表感染1例，切口窦道形成1例、皮缘部分坏死伴钢板部分外露1侧，经过应用清创换药等局部处理后治愈。结论采用延期切开复位内固定治疗跟骨关节内骨折，能有效减少局部并发症，取得良好效果。

Objective To analyze the results of distal tibial calcaneal fracture treated with delayed open reduction and internal fixation. Methods 41 feet of 35 patients with intraarticular fractures of the calcaneus were reviewed. 41 calcaneal fracture were stabilized temporarily by application of plaster splint, bandage immediately. 23 patients were males and 12 were females （mean age 36.7 years; range from 16 to 58 years）, According to Sanders＇ classification, there were 11 cases in type Ⅱ,20 in type Ⅲ, 10 in type Ⅳ. The definitive internal fixations were performed on an average of 10.5 days（range, 7 to 15 days） after injury as soon as the soft tissue recovered. The final outcomes of treatment were evaluated based on clinical rating and radiographic results. Results All patients were available for follow-up at an average of 1.5 years（range, 0.5-3 years） after surgery. There were 14 excellent, 20 good, 5 fair, and 2 poor results according standard of AOFAS. The excellent and good rate was 82.9%, the result was good. The rate of faulty union was14.6%. Among 6 cases, partial necrosis of incision edge occured in 3 cases, sinus of incision edge occurred in 1 cases, partial necrosis of incision edge accompanying superficial infection occurred in 1 case, partial plate was exposed in 1 cases. The complications were successfully treated by local dressing changes. Conclusion This two-stage treatment protocol for calcaneal fractures has some advantages of fewer complications, the results are satsifactory.