累及跟距关节及跟骰关节损伤的跟骨骨折手术治疗

SURGICAL TREATMENT OF CALCANEAL FRACTURE INVOLVING TALOCALCANEAL AND CALCANEOCUBOID JOINTS

目的探讨应用跟骨外侧U形切口入路治疗累及跟距关节、跟骰关节的跟骨骨折方法及疗效。方法 2009年1月-2011年3月,对36例同时累及跟距关节、跟骰关节的单侧闭合跟骨骨折患者,采用跟骨外侧U形切口暴露,跟骨解剖钢板内固定治疗。男27例,女9例;年龄19～58岁,平均38.7岁。按Sanders分型标准:Ⅱ型12例,Ⅲ型20例,Ⅳ型4例。B hler角(6.21±10.48)°,Gissane角(89.85±12.34)°。受伤至手术时间2～14 d,平均4.2 d。结果术后1例切口皮缘浅表坏死,1例切口渗液,均经换药后愈合;其余患者切口均Ⅰ期愈合。36例均获随访,随访时间12～26个月,平均15.2个月。X线片示骨折均愈合,愈合时间8～12周,平均10.6周。关节面复位满意,跟骨高度恢复正常。无内固定物折断及创伤性关节炎发生。术后3个月B hler角为(29.64±5.33)°,Gissane角为(121.75±6.65)°,与术前比较差异均有统计学意义(t=43.800,P=0.000;t=33.200,P=0.000)。术后9～20个月取出钢板,平均11.2个月。在取跟骨钢板术前按Maryland足部评分系统评价疗效,获优17例,良15例,中4例,优良率88.9%。结论跟骨外侧U形切口能充分暴露及复位跟骨骨折,恢复跟骨解剖形态,结合跟骨解剖钢板固定允许早期功能锻炼,是治疗累及跟距关节、跟骰关节跟骨骨折的一种有效方法。

Objective To explore the method and effectiveness of lateral calcaneal U-shaped incision approach to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints. Methods Between January 2009 and March 2011, 36 cases of calcaneal fractures involving the talocalcaneal and calcaneocuboid joints were treated by the lateral calcaneal U-shaped incision approach and calcaneal anatomical plate fixation. There were 27 males and 9 females with an average age of 38.7 years （range, 19-58 years）. According to the Sanders classification criteria, there were 12 cases of type II, 20 cases of type III, and 4 cases of type IV. The B6hler and Gissane angles were （6.21 ＋ 10.48）~ and （89.85 ＋ 12.34）~, respectively. The average time from injury to surgery was 4.2 days （range, 2-14 days）. Results Superficial skin flap necrosis and wound exudate occurred in 1 case respectively, which were cured after dressing change; primary healing was obtained in the other cases. All the cases were followed up 12-26 months （mean, 15.2 months）. The X-ray films showed that all fractures healed with an average healing time of 10.6 weeks （range, 8-12 weeks）. The reduction of articular surface was satisfactory, and the heel height returned to normal. No complication of breakage of internal fixation or traumatic arthritis occurred. The B6hler and Gissane angles were （29.64 ＋ 5.33）~ and （121.75 ＋ 6.65）~, respectively at 3 months after operation, showing significant differences when compared with the preoperative values （t=-43.800, P=0.000; t=33.200, P=0.000）. The average time of plate removal was 11.2 months （range, 9-20 months）. According to Maryland foot score, the results were excellent in 17 cases, good in 15 cases, and fair in 4 cases; the excellent and good rate was 88.9%. Conclusion The lateral calcaneal U-shaped incision approach is an effective method to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints, which can expose the fracture fully, restore the anatomy of the calcaneal bone, and do early exercise under the condition of rigid internal fixation.