手术治疗跟骨关节内骨折疗效分析

Operative treatment of intraarticular calcaneal fracture

目的探讨关节内跟骨骨折的手术疗效及并发症防治措施。方法33例(40足)跟骨关节内骨折患者,SandersⅡ型23足,Ⅲ型15足,Ⅳ型2足。手术切口均为跟部外侧扩大改良切口。术后进行Maryland足部评分,测量术前和术后Bhler角度、跟骨高度。结果33例中,有29例达到解剖复位。术后3个月,Bhler角恢复到正常的85%;术后Maryland评分:23足SandersⅡ型为77～92分,15足SandersⅢ型为70～87分,2足SandersⅣ型为46和68分。17例(20足)优秀,11例(13足)良好,4例(6足)一般,1例(1足)差。术后3例出现感染,1例出现腓肠神经损伤。结论术前全面的骨折评估、优秀的手术技术是保证关节内跟骨骨折疗效的关键,感染除患者自身危险因素外,与手术时机、止血带时间、手术技术相关联。

Objective To evaluate the results of surgical procedure and complications of intraarticular calcaneal fractures.Methods 33 patients（40 feet）with intraarticular calcaneal factures were classified as Sanders type-Ⅱ23 feet,Sanders type-Ⅲ 15 feet,Sanders type-Ⅳ 2 feet.The extended lateral approach was applied in 33 patients.Maryland foot scores were used for evaluation of the results and height of calcaneus were measured in pre-operation and post-operation.Results Anatomic reduction of the posterior calcaneal facet was achieved in 29 patients.In 3 months postoperatively,the Bhler angle was restored to 85% of normal.Maryland foot scores were restored to 77～92 in 23 Sanders type-Ⅱ,70～87 in 15 Sanders type-Ⅲ,46 and 68 in 2 Sanders type-Ⅳ factures.17 patients（20 feet） achieved excellent results,11（13 feet） good,4（6 feet） fair and 1（1 foot） poor.Conclusions Through preoperative evaluation,appropriate operative techniques are key points for a successful treatment of intraarticular calcaneal fractures.Except for the condition of patient,the associated factors included timing of surgery,tourniquet duration and surgical technique.