手法复位辅助手术治疗跟骨骨折

Bone setting manipulation combined with surgery for the treatment of calcaneal fractures

目的:探讨跟骨骨折手法复位对消肿、简化内固定手术操作的临床意义。方法:2005年12月至2010年11月,采用先手法复位待消肿后再行延期手术治疗跟骨骨折42例。男25例,女17例;年龄18～74岁,平均41.4岁;左侧20例,右侧22例。23例采用切开复位钢板固定,19例采用克氏针和空心钉固定。随访评价患者的平均术前、术后消肿时间,手术时间,关节功能及并发症发生情况。结果:本组均获随访,时间3～18个月,平均8.3个月。复位次日疼痛明显缓解,3～5d肿胀基本消退。术中复位简便,手术时间平均90min,术后4～7d消肿,术后未出现皮瓣坏死。术后B觟hler角平均(31±3.2)°,Gissane角(112±5.3)°,跟骨宽度(30.2±0.89)mm。按Maryland足部评分系统评价,优16例,良18例,中6例,差2例。结论:即时手法复位配合延期内固定治疗跟骨骨折可加快术前、术后消肿,简化手术操作。

Objective：To investigate the clinical effects of bone setting manipulation on simplified operation and swelling reduction in treating calcaneal fractures. Methods：From December 2005 to November 2010,42 patients with calcaneal were reviewed,including 25 males and 17 females,ranging in age from 18 to 74 years,with an average of 41.4 years. Twenty patients had fractures in the left and 22 in the right. Twenty three patients were treated with anatomical plate fixation,19 patients were treated with Kirchners wires or cannulated screws fixation. The average period of swelling in soft tissue,joint function and complications were evaluated. Results：Forty two patients were followed up,and the duration ranged from 3 to 18 months,with a mean of 8.3 months. The pain was markedly relieved at the next day after reduction,and the swelling was relieved in 3 to 5 days. The operative was simplified and the average operative time was 90 minutes. The swelling was relieved in 4 to 7 days after the operation,and the necrosis of skin was not found. The average postoperatively Bhler angle was （31±3.2）°. Gissane angle was （112±5.3）°. Calcaneal width was （30.2±0.89） mm. According to Maryland foot function score system,16 patients got an excellent result,18 good,6 fair and 2 bad. Conclusion：The operation is simplified,and skin complications decrease,as well as the detumescence period is shortened.