跗骨窦入路锁定钛板内固定治疗跟骨关节内骨折的疗效

Curative effect analysis of intra-articular calcaneal fractures with conventional locking plate through the tarsal sinus incision

目的探讨跗骨窦入路锁定钛板内固定治疗跟骨关节内骨折的疗效。方法笔者自2014-05—2015-08采用跗骨窦入路锁定钛板内固定治疗23例(32足)跟骨关节内骨折,术后测量跟骨高度、宽度、长度、Bohler角和Gissane角,采用AOFAS踝-后足评分对手术前、术后足部功能进行评估。结果术后未发生切口感染、皮肤坏死、骨不连、骨髓炎及胫后神经、血管损伤等并发症。术后23例获平均14.5(10~18)个月随访。骨折临床愈合时间平均10.5(8~12)周。末次随访时跟骨侧位、轴位X线片显示跟骨骨折块复位及固定良好,跟骨的长度、宽度、高度、Bohler角和Gissane角较术前改善,差异均有统计学意义(P<0.05)。末次随访时疗效按AOFAS踝-后足评分评定:优15例,良6例,可2例,优良率91.3%。结论采用跗骨窦入路锁定钛板内固定治疗跟骨关节内骨折,术后可以获得满意的临床疗效,可减少软组织并发症,是一种安全、有效、可靠的手术入路。

Objective To investigate the clinical efficacy of the surgical treatment of calcaneal fractures through the sinustarsal incision. Methods From May 2014 to August 2015, 23 patients with displaced intra-articular calcaneal fractures ofwere treated by open reduction and internal fixation through a small dorsolateral incision at our department. Regular X-rayfollow-ups were conducted to measure the calcaneal length, width, height, the Bohler＇s angle and Gissane＇s angle. The footfunctions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society （AOFAS） scoringsystem. Results There were no incision infection, skin necrosis or injury to the posterior tibial nerve or vessels occurred aftersurgery. Twenty three patients were followed up for 10 to 18 months （average, 14.5 months）. Clinical union was achieved after8 to 12 weeks （average, 10.5 weeks）. The lateral and axial X-ray films of the calcaneus at the last follow-up showed finereduction and f＇Lxation of the fracture fragments and significant improvements in the length, width, height, and Bohler andGissane angles of the calcaneus compared after operation（P 〈0.05）. For the AOFAS points at the last follow-up, 15 cases wereexcellent, 6 good and 2 fair（the excellent and good rated 91.3%）. Conclusion Open reduction and internal fixation througha the sinus tarsal incision is a good option for surgical treatment of calcaneus fractures, because it has the advantages of directreduction of the articular surface.solid fixation.and limited soft tissue complications.