切开复位内固定加植骨术治疗跟骨关节内骨折移位

目的:探讨跟骨关节内骨折并脱位的分类与治疗方法。方法:本研究包括8例病人、12例跟骨关节。按照Sanders’系统分类;其中Ⅱ型骨折2例,Ⅲ型4例,Ⅳ型6例。采用切开复位内固定并植骨术,手术切口取标准外侧延长切口,骨折块采用小AO桥形钢板固定,植骨材料采用病人自体髂骨。平均随访时间为28.6月(24-33月),采用Creighton-Nebraska健康基金会跟骨骨折评分标准评分。结果:Ⅱ形骨折89.7分,Ⅲ型86.5分,Ⅳ型73.5分。切开复位内固定术治疗跟骨骨折较非手术治疗有显著优越性(P<0.05),在Ⅱ、Ⅲ型骨折中,术中采用植骨与否,无显著差异(P>0605);而在Ⅳ型骨折中,则有显著差异(P<0.05)。结论:本文认为,跟骨关节内骨折并脱位宜采用切开复位内固定术,在Ⅳ型骨折中,宜采用植骨术;此有利于早期负重及避免距下关节面塌陷。Sanders’分类系统对临床治疗具有指导意义。

Objective:To investigate the classifications and treatment of displaced intra-articular fractures of the calcaneus. Method: Twelve displaced intra-articular fractures of the calcaneus in 8 patients were included in this study, classification of calcaneus fractures were based on Sanders' computed tomographic classification systems. There were 2 type Ⅱ fractures;4 type Ⅲ fractures and 6 type Ⅳ fractures. The operations of open reduction and internal fixation (ORIF) and bone grafting were performed using a standard extended lateral approaches, and the fractures were fixed with small fragment AO bridge-plates with autogenous bone grafting. Average follow-up was 28.6 months (range 24-33 months). The Creighton-Nebraska health foundation Assessment Score system for fractures of the calcaneus was used for evaluation. Results: The average score was 89.7 for type Ⅱ 86.5 for type Ⅲ, and 73.5 for type Ⅳ fractures. There was statistically significant superiority treated by ORIF compared with nonoperative methods(P<0.05). In type Ⅱ and type Ⅲ fractures, there were no significant differences between ORIF combined with bone grafting and without bone grafting (P>0.05); whereas in type Ⅳ fractures, the differences were significant with or without bone grafting (P<0.05). Conclusion:We recommended that displaced intra-articular fractures of the calcaneus be treated with ORIF, and combined with bone grafting in type Ⅳ fractures;which has the advantages to prevent subtalar joint collapse and early weight-bearing. Sanders' classification systems can guide the treatment of calcaneal fractures.