移位的关节内跟骨骨折的临床治疗

The treatment of displaced intra-articular calcaneus fractures

目的探讨移位关节内跟骨骨折的手术治疗的方法和疗效。方法2005年2月～2009年1月对21例27足移位的关节内跟骨骨折行手术治疗。采用外侧入路显露跟骨距下关节面及跟骰关节面,术中注意恢复跟骨长度、高度和跟骨结节关节角,尽量解剖复位距下及跟骰关节面,跟骨缺损区域植入Osteoset人工骨+自体髂骨,行跟骨钢板内固定。结果术后随访2～24个月,平均10个月,术后切口均一期愈合,骨折愈合良好,采用Kerr百分制评分标准评价手术效果优良率达85.2%。术后>1年取出18足内固定钢板,无钢板断裂及螺钉松动发生。结论移位的关节内跟骨骨折应争取手术治疗,选择适宜的手术时机,术中微创操作,充分植骨,关节面复位良好,可提高手术疗效。跟骨骨折早晚期并发症的发生与手术时机的选择及手术医生的操作有一定关系。

Objective To investigate the efficiency of surgical treatment of displaced intra-artieular calcaneus fractures. Methods From February 2005 to January 2009,27 displaced intra-articular calcanens fractures of 21 patients were surgical treated. The subtalar-calcaneal and calcaneus-euboid articular surfaces were revealed through the lateral approach. Length and height of calcaneus as well as the Bohler angel were carefully restored,and anatomic reduction of the subtalar-calcaneal and calcaneus-cuboid articular surfaces should be done as long as possible. The bone defect region of calcanens was filled by both artificial bone Ostecst and autologons iliac bone,and calcaneus plates were applied for internal fixation.Results The mean fellow-up period was 10 months（2 - 24 months） .All wound healed I phase.and good fracture healing was observed at latest follow-up.According to Kerr percentile scoringg, total excellent and good rate of the surgery was 85.2% .18 plates were removed more than 1 year after surgery,and no plate abruption and screw loosening occurred. Conclusion The displaced intra-artieular calcaneus fractures should be surgical treated with appropriate timing of operation. Minimal invasive technlque,adequate＇bone implanting and anatomic reduction of the articular surface can improve the surgical outcome. The timing of operation and surgeon＇s technique has something to do with the early and late onset complications in the treatment of this kind of fractures.