跟骨外侧T形切口入路治疗SandersⅣ型跟骨骨折

Lateral calcaneal T-shaped incision in the treatment of Sanders Ⅳ calcaneal fracture

目的：探讨采用跟骨外侧T形切口入路,结合跟骨锁定钢板内固定治疗SandersⅣ型跟骨骨折的临床疗效。方法：2012年1月至2014年6月采用经跟骨外侧T形切口治疗SandersⅣ型跟骨骨折,并收集同期采用改良外侧L形入路病例进行回顾性研究。其中外侧T形入路、改良外侧L形入路各44例;术后随访,X线复查,测量Bhler角和Gissane角并进行比较,根据美国足与踝关节协会（AOFAS）踝与后足功能评分评价疗效。结果：随访时间8-20个月,平均（14±3.2）个月。术后关节面复位良好,跟骨Bhler角和Gissane角恢复满意,无骨折不愈合、无内固定物折断等相关并发症发生,术后T形切口组发生3例皮肤坏死、1例创伤性关节炎;L切口组发生4例皮肤坏死,3例创伤性关节炎。术后6个月根据AOFAS踝与后足功能评分标准进行功能评分,T形切口组优良率为87.8%,AOFAS评分为（88.2±9.1）分;L形切口组优良率为78.7%,AOFAS评分为（80.1±7.6）分。两组AOFAS评分比较差异有统计学意义（t=9.3,P〈0.05）。结论：跟骨外侧T形切口能很好暴露骨折部位,使关节面复位满意,利于跟骨解剖形态的恢复,伤口并发症少,结合跟骨解剖锁定钢板牢固固定,是治疗SandersⅣ型跟骨骨折的一种较理想的方法。

Objective： To study the clinic effect of the lateral calcaneal T-shaped incision approach combined with locking plate to treat Sanders Ⅳ calcaneal fractures. Methods： From January 2012 to June 2014,88 cases were collected into our study and were divided into T-shaped incision group and modificated L-shaped incision group. Each group had 44 cases. X-rays were taken in the regular follow-up. The Bhler angle and Gissane angle were measured. The treatment effect was evaluated according to the ankle and hind- foot score of American Orthopaedic Foot and Ankle Socity（ AOFAS）. Results： The average follow-up period was（ 14 ± 3. 2） months.The recovery of the articular surface reduction and Bler angles and Gissane angles were satisfied. All fractures healed completely. No other internal fixation complications related fracture. There were 3 cases skin necrosis in Tshaped incision group and 4 cases in L-shaped incision group. There were 1 cases subtalar arthritis in T-shaped incision group and 3 cases in L-shaped incision group. According to the ankle and hind-foot score of AOFAS,the excellent and good rate was 87. 8% in T-shaped incision group and 78. 7% in L-shaped incision group,there were significant differences between the two groups（ t = 9. 3,P〈0. 05）. Conclusion： The lateral calcaneal T-shaped incision approach can expose the fracture fully and restore the anatomy of the calcaneus and reduce the wound complications,combined with locking plates is an effective method to treat Sanders Ⅳ calcaneal fractures.