手术治疗涉及距下关节跟骨骨折的临床体会

Surgical management of calcaneal fracture with subtalar joint collapse

背景：对于涉及距下关节的跟骨骨折，由于其骨折类型的复杂性及疗效的不确定性，治疗方法不尽相同。目的：探讨手术治疗涉及距下关节跟骨骨折的方法及疗效。方法：回顾性分析2007年7月至2012年7月手术治疗的29例32足涉及距下关节跟骨骨折患者的临床疗效。根据Sanders分类：II型9足，III型19足，Ⅳ型4足。术前行x线片及CT三维重建测量跟骨高度、宽度、长度，B6hler角及Gissane角，均采取切开复位解剖接骨板内固定治疗。结果：全部获得随防，随访时间为6～20个月，平均17．7个月。术后测量跟骨高度、宽度、长度，Bfhler角及Gissane角均较术前有明显恢复（P〈O．05）。根据Maryland评分系统评价：优17足，良11足，可4足。3例3足于术后8～10个月出现距下关节创伤性关节炎，连续行走500m即出现足部肿痛不适，优良率为87．5％。结论：采用改良L型切口切开复位解剖接骨板内固定治疗跟骨骨折可最大程度达到解剖复位，恢复距下关节关系：辅以早期功能锻炼，可取得良好疗效，是治疗严重跟骨骨折的理想方法。

Background： Calcaneus fracture with subtalar joint collapse is complicated and the therapeutic effect is uncertain. There- fore, there have been many different surgical treatments for it. Objective： To investigate the outcome of surgical treatment for calcaneus fracture with subtalar joint collapse Methods： A total of 29 consecutive patients suffered from calcaneus fracture with subtalar joint collapse and were treated with open reduction and internal fixation with titanium plate in our hospital from July 2007 to July 2012. According to Sand- ers classification, 9 feet were of type II, 19 feet were of type III and 4 feet were of type IV. Calcaneus height, width, length, Brhler tuber angle and Gissane angle were measured by X-ray imaging and CT three-dimensional reconstruction before and after surgery. Results： All the patients were followed up from 6 to 20 months with an average of 17.7 months. Height, width, length, B6hler tuber angle and Gissane angle were significantly improved after surgery （P〈0.05）. According to Maryland scoring, the end fimctional result was rated as excellent in 17 feet, good in 11 feet, and fair in feet, with a total satisfactory result （ex- cellent to good） of 87.5%. Three patients experienced traumatic arthritis in 8-10 months after operation. Conclusions： The surgical treatment of calcaneus fracture with subtalar joint collape that involves open reduction from an extended lateral approach and internal fixation with a calcaneal LCP shows very good preliminary results. It can decrease se- vere disability and improve the quality of life of the patients.