切开复位内固定治疗跟骨关节内骨折疗效与并发症分析

Analysis of the clinical results and complications after operative fixation for displaced intraarticular calcaneal fractures

目的:总结分析切开复位钢板内固定治疗跟骨关节内骨折的疗效及其并发症。方法:收集2005年3月～2008年5月采用切开复位钢板内固定伴必要时生物活性玻璃植骨治疗跟骨关节内骨折36例(共41足,5例为双侧骨折)。男32例(36足),女4例(5足);年龄20～59岁,平均36.5岁;均为闭合性骨折;Sanders分型:Ⅱ型14例(16足),Ⅲ型18例(21足),Ⅳ型4例(4足)。结果:全部患者均获随访,随访时间平均为16个月(8～36个月);采用Maryland评分系统评价:优20足,良15足,可4足,差2足,优良率为85.4%。早期并发症:3例切口皮缘坏死。晚期并发症:2例距下创伤性关节炎。结论:切开复位钢板内固定治疗跟骨关节内骨折能够获得良好的临床疗效,患者主观满意度高。术前充分准备、围手术期重视软组织评估和保护、选择适当手术时机、由有经验的医生完成手术等能够降低术后伤口并发症的发生。

Objective：To analyze and summarize the clinical results and complications after operative fixation for displaced intraarticular calcaneal fractures.Methods：From March 2005 to May 2008,41 cases of calcaneal fractures in 36 patients were treated with open reduction and anatomic plate fixation,most of them were supplemented with bioglass,and 5 with bilateral fractures.There were 32 men and 4 women,with a mean age of 36.5 years（range 20～59 years）.Sixteen of the fractures were on the left side and 25 were on the right.All the fractures were closed.According to Sanders classification,16 cases were type Ⅱ,21 for type Ⅲ,and 4 for type Ⅳ.Results：All the patients were followed up with an average 16 months（ranged from 8 to 36 months）.The clinical results were evaluated according to Maryland Foot Score,and excellent results were achieved in 20 cases,good for 15,average for 4,and poor for 2.The excellent and good rate was 85.4%.Early complications were found in 3 cases of wound necrosis.Late complications were found in 2 cases of subtalar arthritis.Conclusion：Open reduction and internal fixation for displaced intra-articular calcaneal fractures is a good method.The wound complications can be minimized by following measurements：to take care of soft tissue of incision in pre-,intra-and postoperation period;to choose optimal time for operation and finished the operation by the experienced surgeon.