克氏针撬拨结合钢板置入内固定与局部植骨治疗跟骨关节内骨折

Intra-articular calcaneal fracture surgical treatment with Kirschner wire assisted plate fixation plus local bone graft

背景:随着对后足部生物力学及跟骨骨折认识的深入,其临床治疗效果不断提高。目的:观察切开复位钢板置入内固定治疗跟骨关节内骨折的效果。方法:回顾性分析2004-02/2007-10解放军306医院骨科收治的跟骨关节内骨折患者46例52足,钢板置入前CT三维重建对52足跟骨关节内骨折进行分型。按Sander’s分型,分别对Ⅱ型20足,Ⅲ型16足,Ⅳ型16足跟骨关节内骨折采用切开复位克氏针撬拨结合钢板内固定、局部植骨治疗。结果与结论:46例患者均获得随访,随访时间1～3年。所有患者无深部骨性感染,2例出现钢板置入处切口愈合不良,4例置入后出现创伤性关节炎表现。按Maryland足部评分标准评估效果,优38足,良9足,差3足,优良率90%。提示克氏针撬拨复位并钢板置入内固定与植骨治疗跟骨关节内骨折疗效满意。

BACKGROUND：With the in-depth understanding of foot biomechanics and calcaneal fracture,the curative effect on intra-articular calcaneal fracture continues to be improved.OBJECTIVE：To investigate the effect of nonlocking compression plates on intra-articular calcaneal fractures.METHODS：We performed 52 osteosynthesis（46 patients） of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007.Nonlocking calcaneal plates were performed in the 46 patients.Preoperatively,all patients were checked by three-dimensional CT.According to Sander＇s type,there were 20 feet of Ⅱ fracture,16 of Ⅲ fracture,and 16 of Ⅳ fractures.Reconstruction of the calcaneal shape was attempted.During operation,we performed Kirschner wire assisted subtalar distraction bone block and osteosynthesis with lateral-wall compression plate insertion in all cases.The patients were evaluated by the Maryland Scale.RESULTS AND CONCLUSION：All 46 patients were followed up for 1-3 years.Poor wound healing was in 2/46 cases,and traumatic arthritis in 4 cases.No patient had deep osseous infection.According to the Maryland Scale,good was in 38 feet,fair in 9 feet and poor in 3 feet,with an excellent rate of 90%.Kirschner wire assisted plate fixation plus local bone graft is satisfied in the treatment of intra-articular calcaneal fractures.