“U”形外固定架结合闭合手法复位治疗跟骨骨折

The use of U-shaped external fixator combined with close manipulative reduction for calcaneal fractures

目的介绍'U'形外固定架结合闭合手法复位治疗跟骨骨折的方法.方法1997年2月～2002年11月采用自行设计的'U'形外固定架结合闭合手法复位治疗31例34足跟骨骨折患者,均为男性,年龄7～50岁,平均32岁;左足12例,右足16例,双足3例;均为坠落伤.按Essex-Lopresti分型:距下关节外骨折10足,其中结节型3足,跟骨体粉碎型7足;距下关节内骨折24足,其中外侧关节面塌陷型19足,粉碎型5足.术前Bohler角为0°～15°,平均5°.结果全部病例均获得随访,随访时间6～12个月,平均8个月.术后31足跟骨骨折得到复位,足弓及跟骨高度恢复正常,跟骨横径得到矫正,Bohler角为15°～40°,平均25°.患者住院时间5～10d,平均7d.骨外固定架使用时间4～12周,平均8周.2～4.5个月后恢复行走.骨折愈合时间1～3个月,平均2.5个月.无一例发生跟骨高度丢失、骨感染、骨坏死及骨不连.按Fernandez标准评定:优15足,良16足,差3足;优良率为91%.结论'U'形外固定架结合闭合手法复位治疗跟骨骨折,以超踝关节牵伸和固定克服了跟腱挛缩导致的骨折移位,保持了跟骨高度及足部正常的解剖关系,避免了切开复位内固定易产生的伤口并发症.

Objective To manage calcaneal fractures with an U-shaped external fixator combined with close manipulative reduction. Methods From February 1997 to November 2002, 31 patients with 34 calcaneal fractures were treated with self-designed U-shaped external fixator combined with close manipulative reduction. All patients were males aging from 7 to 50 years with an average of 32 years. The external fixation device consisted of two partial rings, three modular connecting rods and several pins. According to Essex-Lopresti classification, there were 10 extra-articular fractures without involving the subtalar joint, and 24 intra-articular fractures involving the subtalar joint. Two upper pins were inserted in cross through the distal tibia, and one of two lower pins was inserted laterally through the anterior part of calcaneus, the other was posterior into the calcaneous tuberosity or larger fragment connecting with Achilles tendon. After the manipulative reduction, the frames were applied. Results 31 calcaneal fractures were found with satisfactory reductions after manipulation. The widths of the heels were restored in certain extent; the heights of foot arch and calcaneus were resumed to normal; the B hler angle increased from 15° to 40° (mean, 25°). The duration of hospitalization was on an average of 7 days. The duration of external fixation was averagely 8 weeks. All patients were followed up with a mean period of 8 months (range, 6 to 12 months). All of the fractures healed well. No nonunion, delayed healing of bone or other complications was found. All patients resumed to walk on foot after 2 to 4.5 months. According to Fernandez scoring system, results were graded as excellent and good in 31(91%). Conclusion Using U-shaped external fixator combined with close manipulative reduction is a satisfying technique to treat calcaneal fractures. By ankle joint spanned traction and fixation, this technique overcomes displacement of fragments caused by contracture of tendo calcaneus, maintains width of heel and biodynamic anatomy of foot, avoids complications of wound caused by open reduction and internal fixation.