波及距下关节的跟骨塌陷性骨折手术治疗

Surgical treatment for fracture of calcaneus involving talocalcaneal joint

目的探讨使用切开复位解剖型钛板内固定治疗波及距下关节跟骨塌陷性骨折的效果。方法2004年4月至2007年11月，使用切开复位解剖型钛板内固定治疗波及距下关节跟骨塌陷性骨折28例（36足），比较手术前后Bohler角、Gissane角、跟骨的宽度及高度。结果术后平均随访20个月，所有患者均恢复正常行走，足弓基本恢复正常，Bohler角由术前平均-6．23°±0．35°恢复至术后平均19．89°±1．28°，跟骨丘部高度由术前平均（36．10±2．38）mm恢复至术后平均（42．80±2．49）mm。结论对于波及距下关节的跟骨塌陷性骨折行切开复位解剖型钛板内固定治疗，既可复位距下关节、Bohler角、Gissane角，又可恢复跟骨的宽度及高度，使其达到解剖复位，患者能早期功能锻炼，是较好的治疗方法。

Objective To approach the treatment of open reduction and internal fixation with titanium plate of anatomic type was applied for ealcaneus fracture involving talocalcaneal joint. Methods Twentyeight patients （36 feet） were performed with open reduction and intemal fixation with titanium plate of anatomic type from April 2004 to November 2007. The Bohler angle, the Gissane angle and the length, breadth, height of calcaneus were compared before and after operation. Results The patients were followed up in an average period of 20 months. All the patients were healed and their arches became normal. The average data of Bohler angle was 19.89° ± 1.28° after operation while -6.23° ± 0.35° before operation. The average height of calcaneus was （42.80 ± 2.49） mm after operation while （36.10 ± 2.38） mm before operation. Conclusions The treatment of open reduction and internal fixation with titanium plate of anatomic type is a kind of good method for caleaneus fracture involving talocalcaneal joint. It can not only resume the Bohler angle and the Gissane angle,but also resume the breadth, height of calcaneus. As a result, it can achieve anatomical reduction and patients can do exercises as soon as possible.