移位性跟骨关节内骨折手术疗效分析

目的探讨切开复位内固定术治疗移位性跟骨关节内骨折的临床疗效。方法回顾性分析2009年6月至2011年1月外侧入路切开复位内固定术治疗22例﹙28足﹚移位性跟骨关节内骨折,SandersⅡ型10足,Ⅲ型14足,Ⅳ型4足。采用X线片影像和MFS﹙Marylandfootscore﹚评分标准评价治疗效果。结果手术平均时间﹙65±23.6min﹚,随访时间6-19个月,1例切口周围坏死,2例出现关节炎表现。术后10-12周时X线片示骨折均获得骨性愈合,无内固定松动断裂、无内外翻畸形等,X线片示Bo hler角由术前4.8°±11.4°恢复至术后末次随访时27.3°±9.7°;跟骨宽度由术前的44.5±4.6mm恢复至术后末次随访时的41.3±3.8mm;跟骨体长度由术前的62.3±8.3mm恢复至术后66.5±7.8mm;跟骨体高度由术前38.3±3.8mm恢复至术后41.2±4.3mm,差异均有统计学意义。术后末次随访时MFS评分优良率为82.1%﹙23/28足﹚。结论恢复跟骨形态同时要注重跟骨后关节面的解剖复位,配合坚强固定和早期的功能锻炼,移位性跟骨关节内骨折可取得良好的临床疗效。

To analyze surgical treatment of displaced intra-articular calcaneal fracture

Objective The study was to analyze the therapeutic effect of Open reduction and internal fixation in treatment of displaced intra-articular calcaneal fracture.Methods A retrospective analysis was done on 22 patients ﹙28 fractures﹚ with displaced intra-articular calcaneal fracture treated with Open reduction and internal fixation via the lateral approach from June 2009 to January 2011.According to the Sanders classification there were 10 typeⅡ,14 type Ⅲ,and 4 type Ⅳfractures.The post-operative effect was evaluated with radiography and MFS ﹙Maryland foot score﹚.Results Operative time was 65 ± 23.6min.All patients were received the follow-up range from 6 to 19 months.All fractures came to bony fusion by the last follow-up with1 foot wound complication and 2 feet trauma arthritis.There was significant difference of Bo hler’s angel between pre-operation 4.8 ± 11.4 ° and post-operation 27.3 ± 9.7 °﹙P〈 0.05）.There were significant difference of calcaneal width between pre-operation﹙44.5 ± 4.6mm﹚and post-operation﹙41.3 ± 3.8mm﹚,length between pre-operation﹙62.3 ± 8.3mm﹚and post-operation﹙66.5 ± 7.8mm﹚,and height between pre-operation﹙38.3 ± 3.8mm﹚and post-operation﹙41.2 ± 4.3mm﹚﹙P〈 0.05﹚.The good rate of post-operation MFS was 82.1% at the last follow up.Conclusion The patients of displaced intra-articular calcaneal fracture could get a good clinical effect via reconstruction calcaneal shape and anatomical reduction of posterior facet,with strong fixation and early functional exercise.