外侧壁重建内固定治疗跟骨关节内骨折

Internal fixation with the lateral wall reconstruction for the intra-articular calcaneal fractures

目的评价外侧壁重建内固定治疗跟骨关节内骨折的疗效。方法回顾性分析2007年8月～2010年5月,我科收治的43例49足移位的跟骨关节内骨折手术病例。手术采用跟骨外侧入路,切开复位后外侧壁重建内固定,术后负压引流时间24～48 h。结果随访3～34个月(平均14个月),骨折均全部愈合,愈合时间为4～8个月。根据Maryland足部评分系统:优27例,良10例,中6例,优良率86%。发生手术并发症4例,3例切口边缘发生浅表坏死,有1例腓肠神经损伤,3例骨折复位丢失。结论切开复位外侧壁重建内固定以及必要的植骨是治疗跟骨关节内骨折的有效办法,正确把握手术时机、骨折复位的操作技巧及关键点、微创操作、术后引流、选择性植骨是减少跟骨关节内骨折手术并发症的关键。

Objective To evaluate the clinical outcomes of internal fixation with the lateral wall reconstruction for the intra-articular calcaneal fractures. Methods From August 2007 to May 2010,43 cases（49 feet） of the intra-articular calcaneal fracture were reviewed.Open reduction and internal fixation with the lateral wall reconstruction plated by the lateral approach was performed.The postoperative negative pressure drainage time was 24-48 h. Results All fractures were healed through 3 to 34 months follow up,with an average of 11 months.The healing time was 4 to 8 months.According to Maryland Scale,27,10 and 6 cases obtained excellent,good,favorable results respectively.The excellent and good rate was 86%.Surgical complications occurred in 4 cases,including 3 cases of necrotic skin of incision,and 1 case of injury of sural cutaneous nerve.There were 3 cases of loss of fracture restoration. Conclusion Open reduction,internal fixation with the lateral wall reconstruction and the selective bone grafting is an effective way for the treatment of intra-articular calcaneal fractures.Correctly holding operative opportunity,the technique of operative reduction,microinvasive operation,postoperative drainage and proper bone grafting are the keys to reduce the intra-articular calcaneal fracture complications.