跟骨钢板治疗跟骨Sanders Ⅲ、Ⅳ型骨折49例临床分析

Treatment for 49 Cases of SandersⅢ,Ⅳ Calcaneal Fractures with Calcaneal Plate

目的：探讨跟骨钢板内固定技术治疗Sanders Ⅲ、Ⅳ型跟骨骨折的临床疗效。方法：回顾性分析2006年1月-2011年3月采用跟骨钢板内固定治疗的病例，共49例51足，其中Sanders分型Ⅲ型38足、Ⅳ型13足，随访时采用Maryland足部评分系统评价术后疗效以及Bohler角、Gissane角和疼痛视觉模拟评分（VAS评分）。结果：所有患者均得到随访，平均随访11个月（8-18个月），根据Maryland足部评分系统：优14足，良29足，可7足，差1足，优良率84．3％。优良率在不同类型骨折中分别为：Ⅲ型33例，占该型86．8％；Ⅳ型10例，占该型76．9％；对术前、术后和随访的Bohler角、Gissane角、VAS评分等因素比较，差异有统计学意义（P〈0．05）。结论：跟骨骨折进行外侧人路手术跟骨钢板复位内固定治疗，得到良好的临床效果，术后Bohler角及Gissane角得到良好的恢复，疼痛明显改善，伤后关节功能恢复好，是治疗Sanders Ⅲ型及以上的跟骨骨折理想方法之一。

Objective：To investigate clinical outcomes of the internal fixation of calcaneal plate in the treatment of Sanders Ⅲ, Ⅳ ealcaneal fractures. Methods： A retrospective analysis from January 2006 to March 2011, a total of 49 cases including 51 feet were treated with calcaneal plate. According to Sanders classification：38 feet of Ⅲ, 13 feet of Ⅳ. The postoperative outcomes were evaluated according to Maryland scoring system, Bohler angle, Gissane angle and visual analogue scale（VAS）. Results：All patients were evaluated. The mean followed up time was 11 month（range 8-18 month）. According to Maryland scoring system：excellent in 14 feet,good in 29 patients,moderate in 7 feet, and poor in 1 foot. The excellent and good rate was 76. 9%. The rate indicated in different types： 33 cases of fiX ：86. 7%. 10 cases of Ⅳ .76. 9%. There were significant differences in Bohler angle,Gissane angle and visual analogue scale in preoperative, postoperative and follow up comparison（P〈0. 05）. Conclusion. Calcaneal fractures could be treated successfully with calcaneal plate by lateral surgical approach,making the postoperative Bohler angle and Gissane angle get a better recovery, as well as the pain and joint function after the injury, which is one of the ideal methods for calcaneal fractures of Sanders Ⅲ and above.