外侧横切口双窗入路钢板固定治疗跟骨关节内骨折

Treatment of intra-articular calcaneal fractures by plate fixation via lateral transverse incisions and double-window approaches

目的探讨外侧横切口双窗入路钢板固定治疗跟骨关节内骨折的临床疗效。方法回顾性分析2014年5月至2016年4月期间安徽医科大学第二附属医院骨科收治的21例(22足)跟骨关节内骨折患者资料。男19例,女2例;年龄为20~60岁,平均38.3岁;左侧13例,右侧8例,双侧1例。跟骨骨折根据Sanders分型:Ⅱ型10足,Ⅲ型11足,Ⅳ型1足。所有患者均采用外侧横切口双窗入路钢板固定治疗。记录患者术后1年的跟骨长度、宽度、高度、Böhler角、Gissane角、末次随访时患足功能恢复情况及并发症的发生情况等。结果21例患者术后获21~44个月(平均36.7个月)随访。术后切口均一期愈合,无切口浅表感染、深部感染及裂开等严重并发症的发生。1例患者术后发生切口皮缘表皮坏死,经换药后治愈。随访期间无一例患者发生距下关节炎。21例患者术前跟骨长度、宽度、高度、Böhler角及Gissane角分别为(68.6±1.2)mm、(46.7±0.8)mm、(39.1±2.0)mm、5.4°±12.1°、104.3°±10.2°,术后1年改善至(71.7±1.6)mm、(48.8±2.0)mm、(32.8±1.3)mm、29.2°±6.8°、120.8°±6.2°,差异均有统计学意义(P<0.05)。末次随访时美国骨科足踝外科协会踝-后足评分平均为92.7分(73~98分);优17足,良3足,中2足,优良率为90.1%。结论外侧横切口双窗入路钢板固定治疗跟骨关节内骨折能获得良好的临床疗效,可减少术后切口软组织并发症和距下关节炎的发生。

Objective To explore the clinical efficacy of plate fixation via the lateral transverse incisions and double-window approaches for the treatment of intra-articular calcaneal fractures.Methods A retrospective analysis was performed on the data of 21 intra-articular calcaneal fractures(22 feet)which had been treated at Department of Orthopaedics,The Second Affiliated Hospital to Anhui Medical University from May 2014 to April 2016.There were 19 males and 2 females,aged from 20 to 60 years(average,38.3 years).The fracture affected 13 left feet and 9 right feet.According to the Sanders classification,10 feet were typeⅡ,11 typeⅢand one typeⅣ.They were treated by plate fixation via the lateral transverse incisions and double-window approaches.Early complications within 3 months after operation,the length,width,height,Böhler angle and Gissane angle of the calcaneus one year after operation,functional recovery of the affected feet at the last follow-up,and complications were recorded.Results The 21 patients were followed up for 21 to 44 months(mean,36.7 months).Incisions were all healed at the first postoperative stage with no serious skin or soft tissue complications like superficial infection,deep infection or wound dehiscence.At the early stage,one patient suffered epidermal necrosis at the margin of incision,which was cured after dressing change.None of the patients developed subtalar arthritis by the last follow-up.The preoperative length,width,height,Böhler angle and Gissane angle of the calcaneus(respectively,68.6±1.2 mm,46.7±0.8 mm,39.1±2.0 mm,5.4°±12.1°and 104.3°±10.2°)were significantly improved to 71.7±1.6 mm,48.8±2.0 mm,32.8±1.3 mm,29.2°±6.8°,and 120.8°±6.2°one year after operation(P<0.05).At the last follow-up,their AOFAS ankle-hind foot scores averaged 92.7 points(from 73 to 98 points);17 feet were rated as excellent,3 as good and 2 as moderate,giving an excellent and good rate of 90.1%.Conclusion Plate fixation via the lateral transverse incisions and double-window approaches can reduce incidences of postoperative soft tissue complications and subtalar arthritis,leading to good clinical results in the treatment of intra-articular calcaneal fractures.