锁定钢板内固定加植骨治疗跟骨关节内骨折

目的探讨锁定钢板内固定加植骨治疗跟骨关节内骨折的疗效。方法采用锁定钢板内固定加陶瓷骨或人工异体骨植骨治疗40例跟骨关节内骨折患者共44足,分析临床疗效。结果切口一期愈合38足,切口持续渗液4足,皮瓣坏死2足。40例均获随访,时间6~20个月。骨折愈合时间3~6个月。Bhler角由术前-15°~5°(-4.16°±3.98°)恢复至术后25°~40°(32.18°±4.28°),Gissane角由术前73.9°~91.5°(84.1°±6.28°)恢复至术后108.8°~117.4°(112.8°±5.63°),跟骨宽度由术前38~45(40.9±2.2)mm恢复至术后30~34(31.2±2.1)mm。术后无骨折畸形愈合、足弓塌陷、腓骨下端撞击综合征等并发症的发生。按Maryland评分标准评定:优29足,良10足,可4足,差1足,优良率88.6%。结论锁定钢板内固定加植骨治疗跟骨关节内骨折,能重建跟骨的大体形态,临床疗效良好。

Locking compression plate internal fixation combined with bone graft on intra-articular cal-caneal fractures

Objective To explore the clinical effect of locking compression plate internal fixation combined with bone graft and artificial allograft on intra-articular calcaneal fractures. Methods A total of 40 cases（44 feet） subjected to intra-articular calcaneal fracture received open reduction and internal fixation surgery with locking compression plate and bone graft and artificial allograft. All cases were retrospectively investigated regarding clinical effect. Results The incisions were healing with 38 feet, there had been persistent effusions in 4 feet, and skin flap necrosis with 2 feet. 40 cases were followed up for 6 - 20 months. Calcaneal fractures were healing from 3 to 6 months. The Bohler angle was -15°-5°（ -4. 16° ±3.98°）in the preoperative, and it recovered to 25° -40°（32. 18°±4. 28°）to the postoperative. The Gissane angle was 73.9° - 91.5° （84. 1° ± 6. 28°） in the preoperative, and it recovered to 108. 8°- 117.4°（ 112. 8° ±5.63°）to the postoperative. The width of the calcaneus was 38 -45（40. 9 ±2. 2）mm in the preoperative, and it recovered to 30 - 34 （31.2 ± 2. 1 ） mm to the postoperative. No fracture malunion, arch collapse and the lower end of fibula impingement syndrome and other complications were found. The effects of treatment were evaluated according to Maryland foot score, which was excellent in 29 feet, good in 10, fair in 4, and poor in 1, the excellent-good rate was 88.6%. Conclusions Locking compression plate internal fixation combined with bone graft can reconstruct calcaneal profiles and gain satisfactory clinical effect in the treatment of intra-articular calcaneal fractures.