改良扩大跟外侧L形入路治疗跟骨关节内骨折

目的 对跟骨经典扩大跟外侧L形入路进行改良,并探讨其临床应用效果. 方法 自2004年7月至2009年1月应用改良扩大跟外侧L形入路对81例89足(8例双侧)跟骨关节内骨折施行切开复位内固定术,观察临床效果.并与同期采用经典跟外侧扩大L形入路的32例患者的疗效进行比较. 结果 所有患者随访6～48个月,平均30.6个月,骨折全部愈合.按Maryland足部评分系统评价术后功能,其中改良组平均(84.37±12.22)分,优良率为83.2%;经典跟外侧扩大L形入路组平均(81.72±13.91)分,优良率为81.3%.两组术后Maryland足部评分值及优良率比较差异均无统计学意义(t=1.014,P>0.05;X~2=0.009,P>0.05).两组术后皮瓣坏死发生率及腓肠皮神经损伤发生率比较,差异有统计学意义(P<0.05). 结论 改良入路不仅具有经典扩大跟外侧L形入路的各种优点,而且最大限度地保护了跟外侧动脉及相伴行的腓肠皮神经,有效预防了术后皮瓣坏死、感染、切口不愈合及术区皮肤感觉功能障碍等并发症的发生.

Modification of expanded lateral L-shaped approach for treatment of intraarticular fractures of calcaneus

Objective To modify the expanded lateral L-shaped approach which is conventionally used to treat intraarticular fractures of calcaneus but likely leads to injury to the artery and sensory nerve at the calcaneal lateral skin area. Methods From July 2004 to January 2009, the modified expanded lateral L-shaped approach was used to treat 89 feet in 81 patients, 8 of whom had bilateral feet injured. The clinical effects were observed and compared with those of the other 32 patients who had been treated with the classic lateral L-shaped approach during the same period. Results The patients were followed up for 3 to 48 (average, 30.6) months. All fractures healed completely. By Maryland foot grading system, the modified group scored 84.37±12.22 averagely, with an excellent to good rate of 83.2%, while the classic group scored 81.72±13.91, with an excellent to good rate of 81.3%. There wee no significant differences between the 2 groups (t=1.014, P > 0.05; X~2=0.009, P>0.05). Only flap necrosis and lesion to sural cutaneous nerve occurred in the 2 groups and there were significant differences between the two (P < 0.05). Conclusion The modified expanded lateral L-shaped approach can protect maximally the lateral pedal artery and its con-comitant sural cutaneous nerve, thus effectively preventing such complications as flap necrosis, incision dis-union and skin functional impairment at the operation area.