跟骨锁定钢板治疗移位的跟骨关节内骨折

Open reduction and internal fixation of displaced intra-articular calcaneal fractures using calcaneal locking plates

目的探讨跟骨锁定钢板治疗移位的跟骨关节内骨折疗效。方法2011年10月—2013年10月，对26例27侧移位的跟骨关节内骨折，经跟骨外侧L形切口在C臂机透视下利用跟骨锁定钢板进行切开复位内固定，其中男性18例18侧，女性8例9侧；年龄24～65岁，平均35．5岁。全部患者均未植骨。术前行跟骨侧位及冠状位三维CT扫描，依此按照Sanders分型：Ⅱ型16侧，Ⅲ型9侧，IV型2侧。术后进行放射学评估，末次随访采用Mar-yland足部评分系统进行评估。结果26例27侧随访5～18个月，平均12个月。骨折愈合时间12～15周，平均13．4周，无延迟愈合及不愈合，骨折端无移位，螺钉无松动、拔出及断钉。术后皮缘坏死1例，切口裂开1例，1例出现腓肠外侧皮神经损伤症状，所有切口均无感染。根据Maryland足部评分标准，患者在末次随访时：优17侧，良6侧，可2侧，优良率85．18％，术后跟骨的宽度、长度、高度、Bfihler角和Gissane角较术前均获得明显改善，差异有统计学意义（P〈0．01）。结论锁定钢板切开复位内固定治疗移位的跟骨关节内骨折，有利于患者早期功能锻炼，是一种较好的治疗方法。

Objective To study on therapeutic effect of calcaneal locking plates on displaced calcaneal intra-articular fractures. Methods From October 2011 to October 2013,26 patients with 27 fractures of displaced calcaneal intra-articular fractures underwent the open reduction and internal fixation using calcaneal locking plates under the perspective of the C-ann X-ray machine from the L incision of ealcaneal lateral pait. The patients were 18 males with 18 fractures and 8 females with 9 fractures, aged 24 to 65 with an average age of 35.5. None of the patients received bone grafting. Before surgeries,side, shaft, as well as coronary position of calcaneal were imaged by Three-dimensional CT scan. According to Sanders classification, 16 fractures were type I1,9 were type Ⅲ ,2 type were Ⅳ. Radiological assessment was performed before and after surgeries. Maryland Foot Score was also employed at the last follow-up. Results 26 patients with 27 fractures got a mean follow-up of 12（5 to 18） months. All of their fractures were healed in a mean time of 13.4（ 12 to 15 ） weeks without delayed union, nonunion, displacement, avascular necrosis, or failure of screws and plates. One got flap edge necrosis, one experienced dehiscence of incision; and one suffered lateral cutaneous sural nerve injury symptoms. No incision infection occurred. 17 cases got excellent grades ,6 cases got good grades and 2 got fair grades according to Maryland Foot Score. The excellent and good rate was 85.18%. The width as well as the length, the height, B？ hler of angle and Gissane angle of calcaneus were getting good recovery（ P 〈 0.01 ）. Conclusion The open reduction and internal fixation with locking plates is a good therapy for intra-articular caleaneal fractures ,which is helpful for early function training.