跟骨关节内骨折内固定手术并发症分析

The analysis of complication following internal fixation of the intra-articular calcaneal fracture

目的探讨跟骨关节内骨折内固定手术并发症的预防和治疗。方法对32例(36足)Sanders分型Ⅱ～Ⅳ型骨折行跟骨外侧"L"形延长切口,直视下以距骨关节面为模板复位、自体骨植骨、解剖形钢板固定。结果采用Mary-land足部评分标准评价手术效果:优25足,良5足,可4足,差2足,优良率为83.3%。发生明确的早期并发症3足,发生率8.3%,其中皮肤边缘坏死1足,感染1足,腓肠神经损伤1足。远期发生明显慢性疼痛2足(5.6%)。结论选择适当的手术时机,术前作周密计划和准备,术中采用全厚皮瓣并避免过分牵拉和反折,复位后通过植骨来支撑关节面骨折块及提高内固定的牢固程度,术后石膏固定并抬高患肢,围手术期应用抗生素等措施可有效减少并发症的发生。出现并发症后,可根据情况作相应处理。

Objective To study the prevention and treatment of surgical complication of intraarticular calcaneal fractures.Methods 32 cases（36 feet） with calcaneal fractures were treated through lateral＂L＂extended incision.With direct visualization,tarlar articular facet as template,all were undergone self-graft and Y-shape plate fixation.Results The clinical results were evaluated according to Maryland Foot score,excellent results achieve in 25 cases,good in 5,fair in 4,poor in 2,excellen and good rate was 83.3%.Early complications were found in 3 cases（8.3%）,of which 1 was skin necrosis,one was infection and one was nerve injury.Late complication were found in 2 cases（5.6%） with obvious chronic pain.Conclusion Serious complications can be minimized in several way as follows optimal time for operation and preoperative design should be carefully considered,a full-thickness flap is recommended in avoidance of excessive distraction,bone grafting is needed to support intra-articular fracture fragment and to enhance the stability of interal fixation,the affected extremity should be immobilized by plaster and elevated,and perioperative use of antibiotics,the appropriate management should be take in cases of complications.