跗骨窦入路联合锁定钢板治疗移位跟骨关节内骨折

Management of displaced intra-articular calcaneal fracture using the sinus tarsi approach and internal fixation by locking calcaneal plate

目的分析移位跟骨关节内骨折经跗骨窦入路联合锁定钢板内固定治疗的疗效。方法回顾性分析采用跗骨窦入路切开复位联合跟骨锁定钢板内固定治疗的移位跟骨关节内骨折11例(12足),其中男性8例,女性3例;年龄16~61岁,平均42.3岁。骨折根据Sanders分型:Ⅱ型7足,Ⅲ型4足,IV型1足。比较手术前后跟骨B9hler角、Gissane角,并按照Maryland足部评分系统进行疗效评价。结果伤后3~6d手术,平均4.5d,均获得随访,时间5~16个月,平均11.4个月。术后无内固定失败、感染坏死等软组织并发症;骨折愈合时间8~16周,平均12.6周。B9hler角由术前平均7.2°提高至术后平均32.3°;Gissane角由术前平均104.3°提高至术后平均131.6°。按照Maryland足部评分系统:优11足,可1足。结论跗骨窦入路联合锁定钢板内固定是治疗SandersⅡ、Ⅲ型跟骨关节内骨折的理想方法,微创,并发症少,疗效满意。

Objective To explore the clinical effects of sinus tarsi approach and internal fixation with locking calcaneal plates for the treatment of displaced intra-articular calcaneal fractures. Methods From Feb. 2015 to Nov. 2016,11 cases（12 feet） were treated by sinus tarsi approach and internal fixation with locking calcaneal plates. There were 8 males and 3 females,aged from 16 to 61 years（mean,42. 3 years）. According to Sander＇s classification and CT scan findings,seven fractures were type Ⅱ,four fractures were type Ⅲ and one was type V. The B9 hler＇s angle and crucial angle of Gissane were measured before operation and after operation. The clinical results were evaluated with Maryland foot scoring system. Results The average time from injury to surgery was 4. 5 d（range,3-6 d）. All cases were followed up from 5 to 16 months（average,11. 4 months）. There was no case of fixation failure,infection,necrosis or other soft tissue complications. Time to union ranged from 8 to 16 weeks（averaged12. 6 weeks）. Preoperatively,the mean B9 hler＇s angle and angle of Gissane were 7. 2° and 104. 3° respectively,which improved postoperatively to 32. 3° and 131. 6°. According to Maryland foot scoring system,11 feet got excellent results,and 1 got fair. Conclusion Open reduction by sinus tarsi approach and internal fixation with locking calcaneal plates is an effective method for treatment of Sanders Ⅱ,Ⅲ calcaneal fracture. It can obtain good reduction and stable fixation with minimal invasion and few complications.