小切口复位植骨空心钉内固定治疗部分跟骨关节内骨折的短期疗效分析

背景:手术治疗是跟骨关节内骨折有效的治疗方法,如何减少手术创伤,提高手术疗效,是临床研究的难题。目的:探讨小切口复位植骨空心钉内固定治疗部分跟骨关节内骨折的短期疗效。方法:2006年1月至2010年1月,对27例(32足)部分塌陷移位的跟骨关节内骨折(Sanders分型为Ⅱ~Ⅲ型)采用距下关节外侧小切口入路、复位距下关节面、同种异体骨移植,中空钉内固定进行治疗。术后患者均石膏托外固定4周。结果:所有患者术后获得6～48个月(平均22.9个月)随访,骨折全部愈合。按Maryland足部评分标准评价手术效果:优22足,良7足,可3足,优良率91%。无一例发生切口皮缘坏死及螺钉断裂。结论:有移位的Ⅱ、Ⅲ型跟骨关节内骨折,采用小切口切开复位植骨空心钉内固定治疗可获得满意疗效,能避免切口缘浅表坏死等并发症的发生,短期疗效可靠。

Short-term efficacy of treatment on part intra-articular calcaneal fractures by open reduction and cannulated screw internal fixation with small incision and bone grafting

Background： Surgical treatment is an effective method for intraarticular calcaneal fractures. How to reduce surgical trauma and improve effectiveness is a difficult problem of clinical research. Objective： The purpose of the study is to explore a calcaneal lateral small incision procedure of open reduction and internal fixation with cannulated screws for part collapsed intraarticular fractures of calcaneus and its clinical outcome. Methods： From January 2006 to October 2009, 32 feet in 27 patients with part collapsed intraarticular calcaneus fractures （Sander＇s type Ⅱ, Ⅲ） were retrospectively studied. The procedure included open reduction of the surface of subtalar joint, bone grafting and internal fixation with cannulated screws through a lateral approach of subtalar joint. Plaster immobilization was performed in all cases for 4 weeks. Results： All the patients were followed up for 6 to 48 months （average 22.9 months）. According to the Maryland system scores, the results were excellent in 22 feet, good in 7 feet, and fair in 3 feet; the excellent and good rate was 91%. No complications such as necrosis of skin around the incision, screw breakage occurred. Conclusions： The open reduction and internal fixation with a calcaneal lateral small incision is effective for displaced calcaneal fractures of Sander＇s typeⅡ and Ⅲ. It can avoid the complication of wound superficial necrosis.