涉及跟骨关节面的粉碎性骨折的手术治疗

Treatment of Comminuted Articular Calcaneus Fracture

目的探讨应用可塑性解剖型钛钢板内固定治疗累及跟骨后距关节面粉碎性骨折的疗效。方法83例96个足跟骨后关节面粉碎性骨折患者,均采用切开复位可塑性解剖钛钢板固定。其中急诊手术44足,择期手术52足。术后随访时间18～36个月。结果近期并发皮缘部分坏死9足,其中急诊手术发生4足,发生率9.1%(4/44);择期手术组发生5足,发生率9.6%(5/52)。远期治疗效果按美国骨科协会足踝外科分会(AOFAS)踝后足评分标准进行功能评分,优54足,良26足,可16足,优良率83.3%(80/96)。经统计学分析急诊手术与择期手术的治疗效果比较无统计学意义(P>0.05),但在不同骨折类型之间治疗结果的差异有统计学意义(P<0.05)。结论可塑性解剖钛钢板内固定是一种治疗跟骨后距关节面粉碎性骨折的有效方法,急诊手术与择期手术比较对疗效无影响,骨折类型是影响疗效的重要因素。

Objective To discuss the treatmenl effect of internal fixation with plastic titanium alloy plate for articular calcaneus fracture. Methods 83 patients （96 feet） with articular calcaneus fracture were treated by open reduction and internal fixation with plastic titanium alloy plate. There were 44 cases of emergency surgery and 52 cases of elective surgery. All the patients were followed up for 18 to 36 months. Results There were 9 cases of complicated skin flap necrosis in short term. Incidence was 9.1%（4/44） in 4 cases of emergency surgery and 9.6%（5/52） in 5 cases of elective surgery. The long-term effects of treatment were evaluated according to AOFAS score system ：excellent in 54 ,good in 26 ,fair in 16. The total good to excellent rate was 83.3% （80/96）. The treatment showed no significant difference （P〉0.05） in emergency surgery and elective surgery,but the differences within type Ⅱ fractures and type Ⅲ ,type Ⅲ and type Ⅳ were statistically signifieant（P〈0.05）. Conclusion Titanium plate internal fixation for treatment of comminuted articular calcaneus fracture is an effective manner. There is no different treatment on the impact of emergency surgery and elective surgery and important factor affecting efficacy is the type of fracture.