跟骨关节内移位骨折的手术治疗

Operative treatment for displaced intra-articular calcaneal fractures

目的探讨跟骨关节内移位骨折的切开复位钢板螺钉内固定手术治疗方法及效果。方法 2005年8月～2010年2月,收治跟骨关节内移位骨折29例34足,根据SANDERS分型,Ⅱ型骨折25足,Ⅲ型骨折6足,Ⅳ型骨折3足。均应用外侧手术入路,或部分辅以内侧切口,切开复位钢板螺钉内固定,术中植骨8足。结果术后全部病例获得随访,平均随访时间15.6个月(9～24个月)。应用影像学检查,术前平均B魻HLER角是(4.5±0.7)°,术后平均是(26.6±1.8)°,与术前比较差异有显著性(P<0.05);术前GISSANE角平均(91.0±5.6)°,术后GISSANE角平均(126.0±4.5)°,与术前比较差异有显著性(P<0.05)。根据MARYLAND足部评分系统(Maryland Foot Sorce)进行结果评估,平均评分在SANDERSⅡ型骨折为86分,Ⅲ型骨折为75分,Ⅳ型骨折为54分;优良率在SANDERSⅡ型骨折为84%,Ⅲ型骨折为67%,Ⅳ型骨折为33%。总优良率为76%。结论切开复位内固定手术治疗跟骨关节内移位骨折能够获得满意的临床效果,尤其是对于SANDERSⅡ型和Ⅲ型骨折。

【Objective】 To explore the operative methods with open reduction and internal fixation and evaluate the clinical effect of the displaced intra-articular calcaneal fractures.【Methods】 There were 34 fractures of the calcaneus treated in 29 patients who were treated with open reduction and internal fixation from August 2005 to February 2008.Fracture classification was based on Sanders classification including 25 type Ⅱ fractures,6 type Ⅲ fractures and 3 type fractures.Extended lateral approach or medial approach assistantly,and fixed the fractures with plate and screw for calcaneus were performed.Bone graft was used in 8 cases.【Results】 All the patients were followed up,and average follow-up was 15.6 months（range from 9 to 24 months）.Evaluated using radiographic examinations,average calcaneal Bhler′s angle was（4.5±0.7）° preoperatively and（26.6±1.8）° postperatively,and calcaneal Gissane angle was（91.0±5.6）° preoperatively and（126.0±4.5）° postperatively.The evaluation of the results by Maryland Foot Sorce for displaced intra-articular fractures of the calcaneus showed that the average score was 86 for type Ⅱ fractures,and 75 for type Ⅲ fractures and 54 for type Ⅳ fractures.Excellent or good clinical results occurred in 84% type Ⅱ fractures,67% type Ⅲ fractures and 33% type Ⅳ fractures.The overall excellent or good rate was 76%.【Conclusion】 Operative treatment with open reduction and internal fixation for the displaced intra-articular calcaneal fractures is recommended,especially for Sanders typeⅡ and type Ⅲ fractures.