跟骨骨折治疗效果不良的原因分析

The Analysis of the Bad Prognostic Causes of the Calcaneal Fractrue

目的 :评价跟骨骨折的治疗效果 ,探讨疗效不佳的原因。方法 :二年内不同类型跟骨骨折 2 8例 (均为闭合性 )。分别选用手法整复跖屈位石膏固定 7例 (均系跟骨关节外骨折 ) ;轴向插钉手法整复牵引后加石膏固定 (插钉组 )12例 (paley 型 2例、 型 5例、 型 3例、 型 2例 ) ;手术开放复位内固定 (手术组 ) 9例 (paley 型 )。随访 2～ 14个月 ,平均 9.5个月。结果 :按张铁良评分标准 ,跟骨关节外骨折组均为优良 ,插钉组 、 型 2例优、5例良 , 型、 型 2例可、3例差 ,手术组 6例良、2例可、1例差。总的效果不良率为 2 8.6 % ,其中 、 型不良率为 5 7.1%。结论 :跟骨关节外骨折的治疗较易收到良好的效果 ,而一但骨折波及到距下关节面则其治疗效果的优良率明显降低。跟骨的增宽。

Objective:To evaluate the effect for treatment of the calcaneal fracture and a discussion of inefficacious causes.Method:Twenty-eight cases were treated with closed reduction and plaster fixtion(7 cases Extraarticular calcaneal fracture) or longitudinal insertion nail(12 cases Intraarticular calcaneal fracture)or open reduction internal fixation(9 cases Intraarticular calcaneal fracture).All patients were followed-up for 2-14 months(an average 9.5 months).The intraarticular calcaneal fracture were classified according to Paley classification.Results:Evaluation was done according to the criterions made by Zhang Tieliang.All patiens of the extraarticular calcaneal fracture had excellent and good outcome.There were fair and poor 5 cases(PaleyⅢ?Ⅳ)in the sertion mail group and 3 cases (Pale Ⅳ) in the operative group.The total rates of bad prognosis were 28.6%.Conclusion:The main causes of bad prognosis are the broadening calcaneus or the lumpy articular surface or narrowing space of the calcaneofibular.