手术治疗关节内跟骨骨折54例临床分析

Clinical analysis of surgical treatment of 54 intra-articular calcaneus fracture

目的探讨跟骨关节内骨折的手术入路、内固定物选择及并发症防治。方法54例(59足)跟骨骨折患者根据Sanders分型采用不同的内固定方法进行固定。Ⅱ型32足采用克氏针及可吸收螺钉固定;Ⅲ型18足采用普通跟骨解剖重建钢板固定;Ⅳ型9足采用跟骨自锁重建钢板固定。结果54例均获随访,时间12～24(18.5±3.2)个月。参照美国足踝外科Maryland足评分系统评价术后足部功能:优29足,良22足,可8足。Ⅱ型32足中优19足,良10足,可3足;Ⅲ型18足中优7足,良8足,可3足;Ⅳ型9足中优3足,良4足,可2足。未发生明显的骨折再移位。3例术后皮缘缺血坏死,通过清创和理疗获得愈合;2例切口感染及时拆线开放引流换药,2个月后愈合而未复发;4例发生腓骨肌腱炎;2例后期随访发生骨性关节炎,在内植物取出时行距下关节融合。结论跟骨骨折应用外侧切口入路,根据损伤类型选择不同的内固定方式,积极预防并发症,能够获得满意疗效。

Objective To investigate the surgical approach,selection of the internal fixation and the prevention of the complications of intra-articular calcaneus fracture.Methods 54 patients（59 feet） with calcaneus fractures were treated with different internal fixations according to the Sanders classification.32 calcaneus fractures of SandersⅡ were treated with K-wire and absorbed screws;18 calcaneus fractures of Sanders Ⅲ were treated with calcaneus anatomy plate;9 calcaneus fractures of Sanders Ⅳ were treated with locking reconstruction plate.Results All of the 54 patients were followed up for 12 ～ 24（18.5 ± 3.2） months after operation.According to Maryland clinical evaluated system：the excellent result was achieved in 29 feet,good in 22 feet,fair in 8 feet.In the 32 calcaneus fracture of Sanders Ⅱ：the excellent result was achieved in 19 feet,good in 10 feet,fair in 3 feet;In the 18 calcaneus fracture of Sanders Ⅲ：the excellent result was achieved in 7 feet,good in 8 feet,fair in 3 feet;In the 9 calcaneus fracture of Sanders Ⅳ：the excellent result was achieved in 3 feet,good in 4 feet,fair in 2 feet;no displacement of the fracture was happened in all of the 54 patients,avascular necrosis of the skin of the incision edge happened in 3 patients and healed by debridement and physical therapy;infection of the incision happened in 2 patients and were healed by drainage and remove the suture in time and were not recurred after 2 months;peroneal tendonitis happened in 4 patients;osteoarthritis of the subtalar joint happened in 2 patients when they followed up and were treated with subtalar arthrodesis when the internal fixation was removed.Conclusions Good result can be achieved if different internal fixations are used and effective measures are taken to prevent the complications according to the different type of calcaneus fracture through the lateral approach.