跟骨骨折外侧钢板内固定术后中期随访和并发症分析

Mid-term postoperative follow-up for lateral plate fixation of calcaneal fractures and its complications

目的探讨跟骨骨折行外侧钢板内固定术后中期疗效及并发症。方法自2009-07-2013-02诊治167例（174足）跟骨骨折，观察骨折愈合情况、Bohler角Gissane角、跟骨高度和宽度，疗效采用AOFAS和MFS评分进行评定。结果167例获得平均36．6（20～49）个月随访，术后AOFAS和MFS评分3组均较有不同程度改善。术后Bohler角Gissane角较术前均有明显提高（P〈0．05）。4例术后过早下地导致关节面再塌陷，3例内固定失败导致塌陷，12例发生浅表组织感染，6例发生深部感染，11例出现切口皮瓣部分坏死，3例出现创伤性距下关节炎、疼痛，5例发生腓肠神经损伤。结论跟骨骨折行外侧钢板内固定术疗效确切，但并发症较多，术后创口皮肤坏死、感染常见。

Objective To explore mid-term postoperative efficacy of the lateral plate fixation of calcaneal fractures and its complications. Methods From July 2009 to February 2013, 167 cases （174 feet） of calcaneal fractures were treated. The follow-up included fracture healing, Bohler angle, Gissane angle, heel bone height and width. The functional Score included AOFAS and MFS （Maryland Foot Score） and complications. Results One hundred and sixty seven cases were followed up for an average 36.6 （20-49）months, postoperative AOFAS and MFS of three groups were improved to varying degrees, Bohler Angle and Gissane Angle were increased significantly after operation （P 〈0.05）. Four cases had joint surface collapse due to early postoperative weight bearing, 3 cases had collapse due to internal fixation failure, 12 cases had superficial tissue infection, 6 cases had deep infection, 11 cases had necrosis of part of incision flap, 3 cases had traumatic subtalar arthritis and pain; 5 cases had sural nerve damage. Conclusion The lateral plate fixation for calcaneal fractures is effective, however with more complications. The postoperative wound skin necrosis and infection are the most common.