跟骨骨折治疗方法的探讨

Exploring of Different Methods in Treating Calcneus Fractures

目的 对 6 2例共 70个跟骨骨折治疗做回顾性分析 ,将手术治疗与非手术治疗组进行疗效比较。方法 手术包括撬拔法、单纯切开复位骨胶填充和外固定、切开复位跟骨钢板和双端螺纹松质骨螺丝钉 (ModifiedHerbertscrew)内固定。 1 1例复位后植骨。平均随访时间 3年 (2 4～ 6 0个月 )。结果 按MarylandFootScore跟骨骨折评分系统进行评价 ,手术组优良率为86 1 % ,疗效明显优于非手术组 70 % (P <0 0 5 )。结论 对跟骨骨折Essex LoprestiⅡ型和Ⅲ型 ,应积极采用开放复位和内固定治疗。双端螺纹松质骨螺丝钉多用于Ⅱ型 ,而跟骨钢板多用于Ⅲ型。骨折治疗的关键是尽可能恢复跟距关节面的相适应性和跟骨的正常解剖形态。

Objective To retrospectively analyze the treatment of 70 displaced intra articular fractures of calcaneus in 62 patients.The result of the operated group with conservative group was compared,there was a significant difference (P<0 05). Methods The operations included poking reduction,open reduction solely,and internal fixation with plates or Modified Herbert screws according to the fracture's type.The bone graft was used in 11 cases.The followed up period was 24～60 months with an average of 36 months. Results Maryland Foot Score System for the fractures of calcaneus was used for evaluation.Satisfaction rate of the operated group was 86.1%,and more than conservative group. Conclusion The authors recommend that type Ⅱ and type Ⅲ fractures of calcaneus according to Essex Lopresti classification were treated with open reduction and internal fixation.The key factors of the treatment are to restore the mutual relation between talus and calcaneus,and anatomic shape of calcaneus.The bone graft would be helpful to prevent secondary collapse of calcaneal body postoperatively.