内固定治疗累及距下关节的粉碎性跟骨骨折

目的:探讨切开复位内固定治疗累及距下关节的粉碎性跟骨骨折的临床效果。方法:采用足外侧"L"形切开复位解剖型钢板内固定治疗累及距下关节的粉碎性跟骨骨折患者50例。骨折按Sanders分型:Ⅱ型6例,Ⅲ例25例,Ⅳ型19例。均为新鲜骨折。结果:50例患者术后获12～35个月,平均20个月随访。无切口和深部骨性感染发生。所有骨折均获骨性愈合。术后出现切口皮缘坏死2例,经换药后愈合。术前Bohler角、Gissane角及跟骨宽度分别为(13.9±5.1)°、(104.6±8.4)°、(39.8±3.3)mm,术后分别为(32.5±3.3)°、(124.1±6.2)°、(31.8±1.5)mm,差异有统计学意义(P<0.01)。根据Maryland足部评分系统评定疗效:优25例,良19例,可6例,优良率为88%。结论:足外侧"L"形入路解剖型钢板内固定具有显露充分、关节面复位满意、固定牢靠和并发症少等优点,对于累及距下关节的粉碎性跟骨骨折疗效确切。

Results of Internal Fixation for Comminuted Calcaneal Fractures Involving Subtalar Joint

Objective:To investigate the application value of open reduction and internal fixation in comminuted calcaneal fractures involving the subtalar joint. Methods: Between May 2003 to Becember 2010,50 cases of comminuted calcaneal fracture involving the subtalar joint were treated by open reduction with a conventional lateral L-incision and internal fixation with anatomic plate.According to the Sanders classification system,6 cases were of type Ⅱ,25 cases of type Ⅲ,and 19 cases of type Ⅳ.All the cases were fresh fractures.Results: The average time of follow-up was 20 months with a span from 12 to 35 months.There were no incision or deep osseous infections.All the fractures were healed.Two patients had minor wound edge necroses and healed by change of dressing. The preoperative X-ray showed that Bohler angle was(13.9±5.1)°,Gissane angle was(104.6±8.4)°,and calcaneal width was (39.8±3.3)mm.The postoperative X-ray showed that Bohler angle was(32.5±3.3)°,Gissane angle was(124.1±6.2)°,and calcaneal width was(31.8±1.5)mm,with a significant difference(P<0.01).According to Maryland criteria,the clinical results were excellent in 25,good in 19,and fair in 6 patients.The excellent and good result was 88%.Conclusion:Anatomic plate by lateral L-approach has some advantages such as good exposure,satisfactory reduction of the articular surface,stable fixation and few complications.It shouid be the effective fixation for comminuted calcaneal fractures involving the subtalar joint .