跟骨关节内骨折手术治疗

Operative treatment for intraarticular fracture of the calcaneus

目的探讨手术治疗跟骨关节内骨折的方法和疗效。方法2007年3月至2007年12月,采用切开复位内固定治疗35例(48足)跟骨关节内骨折。按Sanders分型标准:Ⅱ型13足,Ⅲ型25足,Ⅳ型10足。采用外侧入路重建跟骨距下关节面,术中撬拨复位恢复跟骨长度、高度和跟骨结节关节角(Bohler角)。结果术后随访9～25个月,平均12个月。采用美国足踝外科学会踝与后足功能评分(AOFAS评分)评估手术疗效,优33足,良8足,一般7足,优良率85.4%。没有病例发生切口感染及皮肤坏死。复位结果与功能有显著相关性,手术前后的Bohler角和跟骨交叉角(Gissane角)均有显著性差异。结论手术切开复位内固定是治疗跟骨关节内骨折的有效方法,治疗结果与骨折类型、复位质量、手术时机和方法有密切关系。

Objective To investigate the clinical effect of surgical treatment of calcaneal intraarticular fracture. Methods From Mar. 2007 to Dec. 2007,35 cases（48 feet） of calcaneal intraarticufar fractures were treated with open reduction and internal fixation. According to the Sanders classification,there were 13 feet of type Ⅱ,25 feet of type Ⅲ,and 10 feet of type Ⅳ. During the operation, lateral approaches were used to reconstruct the subtalar joint surface of ealcaneus. We restored the length, height and Bohler＇s angle of the calcaneus by poking reduction technique. Results The cases were followed up from 9 to 25 roonths （12 months in average）. According to Scoring System of AOFAS, 33 were excellent, 8 were good, and 7 were fair, the good and excellent rate was 85.4%. There was no case with incision infection and skin necrosis. There was a significant correlation between reduction quality and clinical outcome. There was a significant difference before and after operation in Bohler＇s and Gissane＇s angle. Conclusions Open reduction and internal fixation is an effective method for the treatment of calcaneal intraarticular fractures. The results are related to fracture type,reduction quality,tinting of surgery and operation methods.