解剖钢板内固定治疗累及跟距关节的跟骨粉碎性骨折35例疗效分析

Effects of treatment of comminuted calcaneal fracture involving in calcaneal-talus joint by anatomic plate internal fixation

目的探讨解剖钢板内固定治疗累及跟距关节的跟骨粉碎性骨折疗效。方法应用解剖型钢板治疗累及跟距关节面的跟骨粉碎性骨折35例,术中恢复关节面及Bohler's角,同时应用解剖型钢板及松质骨螺钉进行内固定,术中均给予髂骨植骨。疗效评价根据Maryland Foot Score足部评分标准,分优、良、可、差四级。结果全组术后早期进行不负重功能锻炼,35例患者均获随访,随访时间平均为6.5(4～24)个月。骨折平均愈合时间为2.9个月,功能恢复优15足(15/40,37.5%),良17足(17/40,42.5%),可5足(5/40,12.5%),差3足(3/40,7.5%),优良率为80.0%。结论解剖型钢板能够有效地支撑塌陷的跟骨关节面,是一种合理治疗跟骨骨折的方法。

Objective To explore the effect of treatment of comminuted calcaneal fracture involving in calcaneal-talus joint by anatomic plate internal fixation. Methods Thirty-five patients suffered from comminuted calcaneal fracture involving in calcaneal-talus joint were treated with the anatomic plate internal fixation combined with cancellous bone screw and ilium grafting. The reduction of both the articular surface of the calcaneal-talus joint and the Bohler＇ s angle had been achieved during operation. The outcomes of both the treatment and the function of joints involved were graded into the excellent, the good, the fair and the poor according to Maryland Foot Score. Results The patients had exercised early after operation. All the 35 cases had been followed up for an average duration of 6. 5 months （ranging from 4 to 24 months）. The average healing time of the fractures were 2.9 months postoperatively. Out of the 35 eases, the outcomes of both the treatment and the function of joints involved were excellent in 15 feet （ 15/40, 37. 5% ）, good in 17 feet （ 17/40, 42.5% ）, fair in 5 feet （5/40, 12. 5% ） and poor in 3 feet （3/40, 7.5% ） according to Maryland Foot Score, and the rate of both excellent and good was 80. 0%. Conclusion Being able to effectively support the articular surface of calcaneus, the anatomic plate is a fine internal fixation device for calcaneal fractures, and it is an ideal method for calcaneal fracture.