切开复位人工骨移植异形钛板内固定治疗跟骨关节内骨折

Open reduction,bone autografting and calcaneus reconstruction internal fixatin of intra-articular fractures of the calcaneus

[目的]探讨跟骨关节内骨折切开复位人工骨填充加钛板内固定手术的治疗效果及优、缺点。[方法]2005年1月～2007年5月,对Sanders分型Ⅱ型以上的跟骨关节内骨折17例19足,男15例18足,女2例2足;年龄19～67岁,平均37.5岁,左侧9例,右侧6例,双侧2例,于伤后5～7d行跟骨外侧切口切开复位撬顶复位人工骨填充加异形钛板内固定手术。[结果]17例19足中,15足切口一期愈合;3足切口边缘血运不良,有渗液,对症治疗后愈合;1足切口渗液经换药治疗愈合。随访时间10～38个月,平均随访19.7个月。无1例感染,骨折平均愈合时间为2.5个月。术后3个月植入人工骨全部吸收。分别在术前、术后跟骨侧位及轴位X线片和CT片上测得Bhler角,跟骨的宽度及轴长,各指标的差异有统计学意义(均P<0.01)。[结论]切开复位人工骨移植加异性钛板内固定是治疗跟骨关节内粉碎性骨折的有效治疗方法。需要注意手术技巧及术后治疗上的几个要点。

[ Objective] To evaluate the results of open reduction with bone autografting and caleaneus reconstruction with internal fixation in treatment of intra - articular caleaneus fracture. [ Methods] From January 2005 to May 2007, 17 cases/ 19 feet of intra - articular ealcaneus fractures received treatment of reconstruction plate and bone autografting, with 15 male/18 feet, 2 female/2 feet. Patients＇ age ranged from 19 to 67 years （ mean, 37.5 years） . Fracture oecmTed in left side in 9 cases, right in 6 cases, both sides in 2 cases. All patients received treatment of open reduction with bone autografting and calcaneus reconstruction with internal fixation. [ Results] All the patients achieved bone union. One stage union was achieved in 15 feet. Poor blood - supply was found in 3 feet and bone union was achieved after systematic treatment. Wound exudation was found in 1 feet, and bone union was achieved after dressing change treatment. All patients were followed up for an average of 19. 7 months （ 10 - 38 months） . The average union time was 2. 5 months, without infection found. X - ray and CT were used to measure Bfhler angle, width and axial length, all the indexed showed significant difference （P 〈 0. O1 ） . According to Maryland function score, there were 15 excellent result, 3 good result, and 1 poor result, with the good -to- excellent result of 94. 7%. [ Conclusion] Operation should be performed 5 - 7 days after injury. Open reduction with bone autografting and internal fixation is suitable for Sanders type Ⅱ, Ⅲ and part of type Ⅳ fractures.