载距突螺钉固定术治疗Sanders Ⅱ型和Ⅲ型跟骨骨折

Sustentaculum tali screw fixation for the treatment of Sanders type Ⅱand Ⅲ calcaneal fractures

目的：探讨载距突螺钉固定术治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法：2010年1月至2012年10月行切开复位内固定治疗跟骨骨折38例38足。根据Sanders分类，Ⅱ型15足，Ⅲ型23足。按固定方式不同分为两组：载距突固定组18例，男13例，女5例，年龄25-55岁，平均（38．56±8．03）岁，每例均有1枚螺钉拧入载距突；载距突未固定组20例，男16例，女4例，年龄29-53岁，平均（42．35±8．29）岁，螺钉未拧入载距突。通过两组术前、术后影像学指标的变化及术后Maryland足评分、VAS评分比较疗效。结果：38例均获随访，时间12～20个月，平均14个月。两组术后均恢复了Btihler角，重建了距下关节。术后1年Maryland足评分，载距突固定组平均88．61±7．59，载距突未固定组平均82．40±9．24，载距突固定组评分高于未固定组，足功能恢复更好。术后1年VAS评分，载距突固定组平均13．39±11．47，载距突未固定组平均22．50±13．10，载距突固定组术后VAS评分更低，足痛更少。结论：使用载距突螺钉固定术治疗SandersⅡ、Ⅲ型跟骨骨折，固定强度大，稳定性高，术后疼痛少，功能恢复更好。

Objective ：To explore the clinical outcomes of open reduction and internal fixation with calcaneal locking plates in treating Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods：From January 2010 and October 2012,38 calcaneal fractures with Sanders type Ⅱ or Ⅲ were treated with open reduction and internal fixation with calcaneal locking plate. According to the Sanders classification, 15 fractures were classified as type Ⅱ , 23 fractures as type Ⅲ. The patients were divided into two groups （group A and B） according to the different fixed methods. Sustentaculum tall was fixed with one screw in group A,including 13 males and 5 females,with a mean age of （38.56±8.03） years old （ranged,25 to 55 ）. And sustentaculnm tali was not fixed in group B,inclnding 16 males and 4 females,with a mean age of （42.35±8.29） years old （ranged,29 to 53）. Clinical effects were evaluated according to the changes of Bohler＇ s angle and the Maryland Foot Score and VAS score. Results ：All patients were followed up from 12 to 20 months with a mean of 14 months. Bohler＇s angles and subtalar joints obtained satisfactory reconstruction in all patients. One year after operation ,the mean Maryland Foot Score was 88.61 ±7.59 in group A;and was 82.40±9.24 in group B; Maryland Foot Score of group A was higher and foot functional rehabilitation was better than group B. The mean VAS score was 13.39±11.47 in group A;and was 22.50± 13.10 in group B;VAS score of group A was lower and foot pain was less than group B. Conclusion： Sustentaculum tali screw fixation has advantages of strong fixed strength, high stability, less postoperative pain, rapid functional recovery in treating Sanders type Ⅱ and Ⅲ calcaneal fractures.