经跟后外侧L形入路治疗跟骨关节内骨折的初步临床报告

L - shaped posterolateral approach for the treatment of intra - articular calcaneal fractures

目的评价跟后外侧L形入路在治疗跟骨关节内骨折的应用价值。方法自2005年4月至2008年10月，采用自行设计的跟后外侧L形入路，对78例82足跟骨关节内骨折实行切开复位内固定术，其中SandersⅡ型25足，Ⅲ型39足，Ⅳ型18足。术后随访3～36个月，观察患足并发症发生情况，功能恢复情况，评定临床疗效。结果骨折复位不佳1例，距下关节痛2例。按Maryland足部评分系统评价术后功能，本组内固定术后总体优良率83．27％，SandersⅡ型、Ⅲ型、Ⅳ型优良率分别为91．82％、88．73％、70．02％，三种类型优良率呈下降趋势，但组间差异均无统计学意义（P〉0．05）。结论与经典跟外侧L形入路相比，跟后外侧L形入路不仅有经典跟外侧L形入路的各种优点，而且视野更大，有利内固定钢板安放；避开了跟外侧动脉及腓肠神经的走行部位，避免了损伤，有效地防止了术后皮瓣坏死、创口感染及延迟愈合、皮肤感觉障碍等并发症。

Objective To evaluate the L - shaped posterolateral approach in the treatment of intra - articular calcaneal fracture. Methods Between April 2005 and October 2008 ,by using self - designed L- shaped posterolateral approach ,82 feet of 78 cases of intra -articular calcaneal fractures received open reduction and internal fixation,including 25 feet with Sanders Ⅱ type,39 feet with Ⅲ type, 18 feet with Ⅳ type. There was a postoperative follow - up of 3 - 36 months to observe the occurrence of foot complications and functional recovery, and assess the clinical efficacy. Results There was one case of bad fracture reposition,and two cases of subtalar joint pain. According to the Maryland Foot Score postoperative functional evaluation, after internal fixation of 82 feet overall excellent and good rate was 83.27%. The fine rate of SandersⅡ type, Ⅲtype, and Ⅳ type was 91. 82% ,88.73%, and 70.02% respectively （P 〉 0.05）. Conclusion In comparison to the classic L- shaped lateral approach, the L- shaped posterolateral approach not only has the former advantages, but also a greater field of vision, enabling placement of internal fixation plate, avoiding the injures of .artery and nerve, and effectively preventing the postoperative complications.