跟骨关节内移位骨折微创手术治疗临床疗效分析

目的探讨微创手术治疗跟骨关节内移位骨折的临床疗效。方法自2009-03－2010-10，采用小切口置入跟骨解剖钢板加压螺栓内固定治疗106例（131足）跟骨关节内骨折，其中SandersⅡ型59足，Ⅲ型57足，Ⅳ型15足。术后根据X线片和CT评估骨折复位质量，应用AOFAS评分标准评估患足功能恢复。116足经后足外侧纵形入路治疗，14足行跗骨窦入路。1例SandersⅣ型骨折同时行外侧纵形人路和跗骨窦人路治疗。结果本组手术时间平均83（60～135）min。Bohler角术前平均-1．7°，术后平均29°。骨折复位质量良好者达96．2％。术后24个月84例（95足）获得随访，患足功能恢复优34足，良47足，可11足，差3足，优良率85．3％。结论应用解剖接骨板加压螺栓系统微创内固定治疗跟骨关节内骨折可获得满意疗效。

Analysis of functional outcomes of displaced intra-articular calcaneal fractures treated in a minimally invasive internal fixation

Objective To explore the clinical outcomes of intra-articular calcaneal fractures minimally invasive treatment. Methods From March 2009 to October 2010, 131 feet of intra-articular calcaneal fractures in 106 patients were treated using minimally invasive anatomical plate and compression bolts for internal fixation, including Sanders type Ⅱ 59 feet, type Ⅲ 57, type Ⅳ 15. Postoperative assessment of the quality of fracture reduction was performed according to the X-ray and CT. The patients were followed up, and the functional outcomes were assessed with American Orthopaedic Foot ＆ Ankle Society （AOFAS） scores. Among 131 fractures, 116 fractures were treated via longitudinal approach, 14 fractures were treated via sinus tarsi approach and I fracture via both longitudinal approach and sinus tarsi approach. Results The average operation time was 83 minutes （range, 60-135 minutes）. The pre- and post- operative Bohler was -1.7° and 29° on average, respectively. About 96.2% fractures were assessed as good. At 24-month follow-ups, according to AOFAS scoring system, the excellent, good, fair and poor results were achieved in 34, 47, 11, and 3 fractures, respectively. The good to excellent rate was 85.3%. Conclusion The treatment of intra-articular calcaneal fractures with anatomical plate and compression bolts can yield good to excellent functional outcomes.