双切口接骨板内固定治疗Sanders Ⅱ、Ⅲ型跟骨骨折

Double incision approach and plate internal fixation for the treatment of calcaneal fractures of Sanders types Ⅱ and Ⅲ

目的探讨双切口入路手术治疗SandersⅡ、Ⅲ型跟骨骨折的临床疗效。方法对22例SandersⅡ、Ⅲ型跟骨骨折患者采用双切口切开复位、跟骨异形接骨板内固定。术后观察切口愈合、功能及并发症发生情况,通过X线及CT检查评价骨折复位情况,测量B9hler角和Gissane角,根据AOFAS踝-后足评分标准进行功能评价。结果患者均获得随访,时间10~22个月。22例跟骨骨折患者均获满意复位,均达到骨性愈合。2例手术切口延迟愈合,经局部换药治愈。患者均未出现切口周围皮肤坏死。术后B9hler角由术前5.2°±4.5°改善为26.5°±4.2°,Gissane角由术前95.4°±4.8°改善为111.2°±6.8°,差异均有统计学意义(P<0.05)。末次随访AOFAS踝-后足评分:优11例,良8例,可3例。结论双切口入路手术治疗SandersⅡ、Ⅲ型跟骨骨折具有创伤小、易于复位、固定及切口并发症少的优点。

Objective To investigate the clinical effect of minimally invasive double incisions approach and plate in-ternal fixation for the treatment of calcaneal fractures of Sanders types II and IH. Methods The 22 patients with calcaneal fractures of Sanders types II and IH were treated through the minimally invasive double incisions approach and calcaneal plate internal fixation. Postoperatively, wound healing,function and complications were observed, and X-ray and CT scans were evaluated carefully to determine fracture reduction. Functional recovery was evaluated ac-cording to the ankle and hind-foot score standard of American Orthopedic Foot and Ankle Society （ AOFAS） . Results All 22 patients obtained satisfied reduction and bony union after 10 -22 months follow-up postoperatively. Two pa-tients experienced delayed wound healing which were cured by local dressing change. There were no necrosis of skin around the incision. The B^jhler angle increased significantly from 5. 2° ±4. 5°preoperatively to 26. 5° ±4. 2°,and the Gissane angle increased from 95. 40 ±4. 80to 111. 2 0 ±6. 80at the last follow-up（P 〈 0. 05） . By the last AOFAS sco-ring ： excellent 11 cases, good 8 , fair 3. Conclusions The double incisions approach is characterized by minimally invasive, easy reduction and few complications.