跟骨关节内骨折的手术治疗

Surgical Treatment for Intra-articular Calcaneal Fracture

目的探讨跟骨关节内骨折切开复位钢板内固定手术治疗的效果。方法笔者自2004年2月．2007年10月收治46例（52足）跟骨关节内骨折术前进行CT三维重建，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46例获得1～3年的随访，平均25个月。所有患者无深部骨性感染，2例出现术部切口愈合不良，经过清创术结合VSD植入术完全愈合。4例术后出现创伤性关节炎表现。术后按Maryland评分系统进行评估，总体优良率为90．4％。结论对移位的跟骨关节内骨折切开复位内固定已经成为一种标准的手术。其对于关节内跟骨骨折行内固定治疗有较少并发症和满意结果的优点。但应考虑手术的适应证和禁忌证．同时密切关注并发症。

Objective To investigate the results of the nonlocking compression plates for treatment of the intra-articular calcaneal fracture. Methods Forty six patients（52 osteosynthesis） of intra-articular calcaneal fractures were performed using the standard extended lateral approach from February 2004 to October 2007. Forty-six operations using nonlocking calcaneal plates were performed. Before operation, all patients were checked by 3D-CT. During operation, Kirschner wire assisted subtalar distraction bone block and osteosynthesis with lateral-wall compression plate insertion in all cases were performed. The patients were evaluated by the Maryland Scale. Results All 46 patients were followed up for a mean of 25 months（1 -3 years）. Wound healing complications were 2/46 （4.3%）. No patient had deep osseous infection. Preoperative size of Bohler angle correlated with postoperative clinical results. There were no late complications necessitat- ing corrective procedure or arthroscopy. Four patients had trauma-related arthritis. The overall results according to the Maryland Scale were good or excellent in 94.2%. Conclusion Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with nonlocking compression plates confirmed for all Sanders types of intra-articular calcaneal fractures. But we need to consider carefully the indications and contraindications to surgery.