足跟后方联合跗骨窦入路小切口切开复位接骨板内固定治疗跟骨闭合性骨折

Treatment of closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision

目的探讨足跟后方联合跗骨窦入路小切口切开复位接骨板内固定治疗跟骨闭合性骨折的疗效。方法回顾性分析广东省云浮市人民医院骨科一区2016年2月至2019年2月采用足跟后方联合跗骨窦入路小切口切开复位接骨板内固定治疗的20例(25足)跟骨闭合性骨折患者。男16例,女4例;年龄16~60岁,平均41.8岁;骨折按Sanders分型:Ⅱ型3例,Ⅲ型15例,Ⅳ型2例。采用牵引、挤压、撬拨及跗骨窦窗直视下对骨折进行复位,足跟后方小切口置入接骨板,闭合拧入螺钉固定。术后观察骨折愈合情况及跟骨长度、宽度、高度、Böhler角、Gissane角及美国足踝外科协会(AOFAS)的踝-后足评分的改善情况。结果单足骨折手术时间45~70 min,平均64.5 min;术中单足透视3~6次,平均4.5次。术后1例1足局部出现约0.5 cm×0.3 cm的皮肤坏死,经换药处理后愈合,其余患者均未出现伤口并发症。所有患者术后随访6~36个月,平均17.3个月。骨折愈合,骨痂塑形好,后关节面平整,骨折愈合时间4~6个月。末次随访时跟骨长度(80.5±4.2)mm、宽度(44.8±5.2)mm、高度(44.4±3.0)mm、Böhler角25.0°±5.1°、Gissane角113.8°±8.6°较均术前[(79.4±4.5)mm、(50.5±6.3)mm、(40.0±4.5)mm、12.0°±13.8°、107.0°±13.3°]改善,差异有统计学意义(P<0.05)。足部功能恢复按AOFAS的踝-后足评分评价:优20足,良3足,可2足,优良率为92.0%。结论足跟后方联合跗骨窦入路小切口切开复位接骨板内固定治疗跟骨闭合性骨折,具有切口小、骨折复位好等优点,临床效果好。

Objective To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures.Methods A retrospective study was done of the 20 patients(25 feet)who had been treated at Ward One,Department of Orthopaedics,People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal fractures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision.They were 16 males and 4 females,aged from 16 to 60 years.According to the Sanders classification,there were 3 cases of typeⅡ,15 cases of typeⅢand 2 cases of typeⅣ.Their fractures were reduced by traction,extruding,prying and direct visualization through the tarsal canal window;the bone plates were inserted through a small incision at the back of the heel and fixated by screws.Postoperative observation was done to address fracture healing,and length,width,height,Böhler angle and Gissane angle of the affected calcaneus,as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society(AOFAS)evaluation.Results The operation time for a single foot ranged from 45 min to 70 min,averaging 64.5 min;the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times,averaging 4.5 times.Local skin necrosis of about 0.5 cm×0.3 cm appeared in one foot after operation but responded to dressing change.No other wound complications occurred.Their follow up was carried out for 6 to 36 months(average,17.3 months).The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months.The length(80.5 mm±4.2 mm),width(44.8 mm±5.2 mm),height(44.4 mm±3.0 mm),Böhler angle(25.0°±5.1°)and Gissane angle(113.8°±8.6°)of the calcaneus at the last follow up were significantly improved than the preoperative values(79.4 mm±4.5 mm,50.5 mm±6.3 mm,40.0 mm±4.4 mm,12.0°±13.8°and 107.0°±13.3°)(all P<0.05).By the AOFAS ankle-hindfoot scale,functional recovery of the foot was excellent in 20,good in 3 and fair in 2 cases,giving an excellent to good rate of 92%.Conclusion In the treatment of closed calcaneal fractures,open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outcomes due to its advantages of small incision and fine fracture reduction.