I.T.S.锁定钢板治疗跟骨关节内骨折的近期疗效

PRELIMINARY EFFECTIVENESS OF I.T.S.LOCKING PLATE FOR INTRA-ARTICULAR CALCANEAL FRACTURES

目的总结I.T.S.锁定钢板治疗跟骨关节内骨折的近期疗效。方法 2010年7月-2011年7月,收治18例跟骨关节内闭合骨折患者。其中男10例,女8例;年龄25～64岁,平均46岁。骨折按Sanders分型:Ⅱ型3例,Ⅲ型9例,Ⅳ型6例。受伤至手术时间5～11 d,平均6 d。待软组织条件改善后,行经外侧L形扩大切口切开复位I.T.S.锁定钢板内固定。结果术后1例患者出现切口浅表感染,经换药后愈合;其余患者切口均Ⅰ期愈合。16例获随访,随访时间12～18个月,平均14个月。X线片示骨折均愈合,愈合时间10～14周,平均12周。随访期间无内固定失效、腓骨肌腱激惹等并发症发生。1例术后11个月X线片示距下关节炎,伴轻度疼痛,给予保守治疗后症状明显缓解。末次随访时,B hler角从术前(12.9±3.2)°增加至(33.8±4.0)°,差异有统计学意义(t=22.78,P=0.00);Gissane角从术前(83.6±6.4)°增加至(119.9±8.5)°,差异有统计学意义(t=17.02,P=0.00);美国矫形足踝协会(AOFAS)踝与后足评分系统评分为(80.3±7.9)分,疼痛视觉模拟评分(VAS)为(1.3±1.2)分。结论采用I.T.S.锁定钢板治疗跟骨关节内骨折,可获得骨折端的稳定固定,近期疗效满意。

Objective To summarize the preliminary effectiveness of I.T.S. locking plate for intra-articular calcaneal fractures. Methods Between July 2010 and July 2011, 18 cases of intra-articular calcaneal fractures were treated. There were 10 males and 8 females with an average age of 46 years （range, 25-64 years）. According to Sanders classification system, there were 3 cases of type II, 9 cases of type III, and 6 cases of type IV. The disease duration was 5-11 days （mean, 6 days）. Open reduction and internal fixation with I.T.S. locking plate were performed via an L-shaped lateral extending incision. Results Superficial infection occurred in 1 case, and was cured after dressing changing; healing of incision by first intention was obtained in the other cases. Sixteen cases were followed up 14 months on average （range, 12-18 months）. X-ray films demonstrated the bone union in all cases with an average union time of 12 weeks （range, 10-14 weeks）. No implant failure or irritation of peroneal tendon occurred during follow-up. X-ray films showed subtalar post-traumatic arthritis with mild pain in 1 case at 11 months after operation, which was relieved by conservative treatment. At last follow-up, the Behler angle was improved from （12.9 ± 3.2）° preoperatively to （33.8 ± 4.0）°postoperatively, showing significant difference （t=22.78, P=0.00）; the Gissane angle was improved from （83.6± 6.4）° preoperatively to （119.9 ±8.5）° postoperatively, showing significant difference （t=17.02, P=0.00）. The visual analogue scale （VAS） score was 1.3 ± 1.2, and the ankle and hindfoot scale of American Orthopaedic Foot and Ankle Society （AOFAS） was 80.3 ±7.9 at last follow-up. Conclusion Treatment of intra-articular calcaneal fracture with I.T.S. locking plate can obtain a stable fixation, which is a safe and effective method.