跟骨伴其周围骨骨折的临床特点及治疗

Characteristics and surgical treatment of combined calcaneal fractures

目的 探讨跟骨伴其周围骨骨折的临床特点及手术治疗.方法 2004年2月至2007年9月手术治疗13例17足跟骨伴其周围骨骨折,其中跟骨合并同距骨骨折8足、同侧内外踝骨折5足、同侧Pilon骨折4足.按踝及后足骨折处理原则对跟骨周围多发骨折进行复位内固定;对17足中15足跟骨骨折采用切开复位克氏针、螺钉或钢板内固定;2足采用一期距下关节融合.术后X线片评估内固定及骨折愈合等情况,Maryland足部功能评分系统评价功能疗效.结果 13例患者均获得16.0～33.0个月随访,平均随访时问26.5个月.1例开放性创面术后10 d出现浅表感染.术后4-6个月X线片示所有骨折均愈合,17足跟骨外形基本恢复正常,无钢板、螺钉断裂等;术后9个月至末次随访X线片示3例出现距下及踝关节轻度骨性关节炎,5例距骨骨折出现不同程度的囊性变,2例出现坏死.Maryland足部功能评分优3足,良6足,可5足,差3足,优良率为52.9%.结论 跟骨伴其周围骨骨折是以跟骨粉碎性骨折为主同时合并踝及后足部位骨折的一种高能量损伤,取得相对满意疗效关键在于术前必须对创面及软组织损伤进行良好的评估和处理,术中需恢复跟骨的基本形态和负重力线、简单有效的内固定或一期距下关节融合,同时对合并其周围多发骨折进行良好的复位固定及术后有计划的康复训练.

Objective To discuss the characteristics and experience for surgical treatment of combined calcaneal fracture.Methods Between February 2004 and September 2007,17 foots of 13 patients with combined calcaneal fractures underwent surgical operations.Among 17 calcaneal fractures,8 combined with ipsilateral talus fractures.5 combined with trimalleolar fractures,4 combined with Pilon fractures.Firstly.fractures of hinder foot were treatment with open reduction and internal fixation according to the principle.Of all.15 fractures were treated with screws or titanic plate plus open reduction and internal fixation.the rest 2 fractures were treated with subtalar arthrodesis.Postoperative X-ray assessed the internal fixation and union of fractures.The foot function was evaluated by the Maryland Foot Score.Results A total of 13 patients were all followed up for 16.0-33.0 months（average 26.5 months）,superficial infection was found in a patient with open wound 10 d after surgery.All the bone fractures united after surgery from 4 to 6 months.Morphous improvement of the calcaneal were proved by X-ray films and there here was no plates and screws＇breakage,loosening.Mild osteoarthritis in Subtalar and ankle joints were found by X-ray after surgery from 9 months to last follow-up.Cystic degeneration and necrosis were found in 5 and 2 cases of talus fractures respectly.According to Maryland Foot Score,excellent was in 3 foots,good in 6 foots,fare in 5 foots and poor in 3 foots.with excellence rate of 52.9%.Conclusions Combined calcaneal is a calcaneus-based concomitant ankle and foot fractures after a high-energy injury.Good deal of soft tissue and correct design of operation pre-operatively,restoration of form and power lines of calcaneal,effective bone graft,right place of simple internal fixation or subtalar arthrodesis and good reduction and internal fixation of other fracture in hinder foots intra-operatively and correct function postoperatively are key points to have a relatively satisfied treating effect of combined calcanean fractures.