切开复位钢板内固定加植骨术治疗Sanders Ⅱ～Ⅳ型跟骨骨折的临床疗效分析

Clinical analysis of open reduction and internal fixation with bone-grafting for the treatment of Sanders Ⅱ~Ⅳ type calcaneal fractures

目的:探讨切开复位钢板内固定加植骨术治疗Sanders Ⅱ～Ⅳ型跟骨骨折的临床疗效。方法:选取2011年1月—2012年11月接受治疗的跟骨骨折患者36例(39足),所有患者均采取外侧"L"切口入路,锁定钢板内固定治疗,对局部塌陷骨缺损较多者取同种异体骨或自体髂骨植骨治疗,并对术后治疗效果进行评价。结果:36例患者均获得随访,随访时间为12~30个月。至随访结束时,6例患者已行内固定取出术。随访患者均已完全愈合,其中钢板螺钉松动0例,术后2个月感染1例,行内固定取出术及清创后恢复良好,术后出现左足疼痛者1例,给予内固定取出及关节融合术治疗。按照Maryland足部评分标准,39足中优14足,良20足,可4足,差1足,优良率为87.18%。结论:切开复位钢板内固定加植骨术治疗跟骨骨折的临床疗效显著。合理的手术时机、术中注意严格规范操作是手术成功的关键。

Objective：To investigate the clinical effect of open reduction and internal fixation with bone - grafting for the treatment of Sanders Ⅱ～Ⅳ type calcaneal fractures. Methods：Thirty- six 36 cases （39 feet） being severe calcaneal fractures were chosed from January 2011 to November 2012, all patients were treated by ‘L＇ lateral incision,locking plate fixation, then evaluating the therapeutic effect of patients after operation. Results：All the 36 patients were followed up for 12 -30 months, av- erage 14 months. At the end of the follow - up ,6 patients had been removed the locking plate. All the followed up patients have been completely healed. Among them, the plate and screw loosening in 0 case, 1 case had postoperative infection in 2 months later after the operation, which been recovered by removing the internal fixation and debridement surgery. 1 case was with left foot pain after the surgery,which was removed internal fixation and had arthrodesis. Maryland foot score system was using to evaluate the postoperative fcution when the cases were followed up. The results showed 14 excellent,20 good,4 faer and 1 poor, the excellent and good rate was 87.17%. Conclusion： The clinical curative effect of open reduction and internal fixation with bone graft in the treatment of calcaneal fracture is obvious. Good timing and strict standard in operation are the key to success.