跟骨骨折治疗方法的疗效观察

目的比较跟骨骨折不同治疗方法的效果。方法88例96足跟骨骨折分成三组,分别应用撬拨复位石膏外固定、切开复位钢板内固定、可调节跟骨骨折外固定器治疗,术后从Bhler角的恢复、主观症状、并发症三个方面进行比较分析。结果可调节跟骨骨折外固定组在恢复Bhler角、术后主观症状改善、减少并发症方面优于撬拨复位石膏外固定组及切开复位内固定组。结论可调式跟骨骨折外固定器治疗跟骨骨折疗效优于撬拨组和内固定组。     

跟骨整复固定器治疗跟骨骨折

目的评价跟骨整复固定器治疗跟骨关节内骨折的疗效。方法36例42足跟骨关节内骨折按paley分型，剪力骨折8足，舌型骨折13足．中央塌陷型11足．粉碎型10足。对36例42足跟骨骨折用撬拨复位跟骨整复固定器固定治疗，随访33例38足，随访时间3～39个月．平均18．4个月。结果按Margland足部评分系统(Margland Foot Score)评价术后功能，本组38足优良率84．2％。结论撬拨复位跟骨整复固定器治疗跟骨骨折是一种治疗跟骨骨折的有效方法。     

微创撬拨复位钢针并石膏固定治疗Sanders Ⅱ型、Ⅲ型跟骨骨折

目的观察应用微创经皮撬拨复位钢针内固定并石膏外固定方法治疗SandersⅡ型、Ⅲ型跟骨骨折的临床疗效。方法对42例SandersⅡ型、Ⅲ型跟骨骨折,采用C臂X线机下钢针撬拨复位钢针内固定并石膏外固定。结果 42例SandersⅡ型、Ⅲ型跟骨骨折术后12个月复查跟骨轴位侧位片,距下关节面达到或者接近解剖复位(移位≤2 mm)Bohler角30°,Gissane角125°。经随访12~24个月,均无针道感染、骨折再移位及足弓塌陷等并发症发生,患足外形良好,按Maryland足部评分系统进行功能评估,优25例,良12例,可5例,优良率达88%。结论明确跟骨骨折治疗原则,合理选择撬拨复位钢针固定适应症及禁忌症并掌握适当手术时机及娴熟操作技巧,采用经皮撬拨复位钢针并石膏固定方法治疗SandersⅡ型、Ⅲ型跟骨骨折,具有微创,固定可靠,简便易行,并发症少等优点。     

经皮穿针撬拨复位固定治疗跟骨骨折

目的评价跟骨骨折采用经皮穿针撬拨复位固定的治疗效果。方法 46例52足跟骨骨折应用经皮穿针撬拨复位固定治疗。结果获得随访43例48足,优良率90%。结论应用经皮穿针撬拨复位固定的方法治疗跟骨骨折,能够取得较好的临床效果,是一种操作简单、组织损伤小、并发症及后遗症轻、经济实用的治疗方法。     

撬拨复位多枚空心钉内固定治疗跟骨骨折

目的观察应用撬拨复位多枚空心钉内固定治疗跟骨骨折的疗效。方法跟骨骨折47例,除1例改用切开复位钢板内固定外,其余患者均采用撬拨复位多枚空心钉内固定。结果全部病例术后无感染及皮肤坏死、断钉等并发症,骨折愈合时间均不超过3个月,术后Bohler角度平均为37.3°。根据Fernandez评分标准,46例采用空心钉内固定者,优24例,良19例,一般3例。结论撬拨复位多枚空心钉内固定是一种治疗PaleyⅠ、Ⅱ、Ⅲ型跟骨骨折较好的方法。     

经皮撬拨复位内固定治疗跟骨关节内骨折的体会

跟骨骨折是足部的常见损伤,其中关节内骨折约占跟骨骨折的70%,以青壮年伤者最多,严重损伤易遗留伤残。我院骨伤科20多年来采用C型臂透视下经皮骨圆针撬拨复位内固定,配合手法整复、石膏靴外固定治疗跟骨关节内骨折,取得满意疗效。     

波及跟距关节的跟骨骨折的治疗

目的：探讨波及跟距关节跟骨骨折的优选治疗方法。方法：对1992年1月2002年9月收治的62例(66足)波及跟距关节的跟骨骨折分别采用石膏外固定法、手法复位石膏外固定法、撬拨复位石膏固定法进行治疗，并对其疗效进行评估。结果：所有病例随访2个月～10年，Essex-Lopresti Ⅰ型骨折单纯石膏固定法平均得分96．5，撬拨复位法平均得分98．5；Ⅱ型骨折手法复位 管型石膏固定法平均得分75．6，撬拨复位法平均得分91.8；Ⅲ型骨折手法复位 管型石膏固定法平均得分45．6，撬拨复位法平均得分70．3。结论：Ⅰ、Ⅱ型骨折用撬拨复位可取得较满意效果，Ⅲ型骨折手术治疗为首选。     

闭合复位空心钉固定治疗Ⅱ型跟骨舌状骨折

目的探讨闭合复位空心钉固定治疗Ⅱ型跟骨舌状骨折的疗效。方法采用双骨圆针撬拨复位法对35例Ⅱ型跟骨舌状骨折行闭合复位空心钉固定术。结果23例随访5～20个月,平均18个月,根据Maryland评分系统进行术后功能评价,优18例,良5例,优良率100%。结论Ⅱ型跟骨舌状骨折用双骨圆针撬拨复位结合空心钉固定治疗可以达到解剖复位,坚强固定,疗效满意。     

跟骨骨折治疗研究进展

跟骨骨折是常见的足部损伤,可选择非手术治疗、切开复位内固定、微创撬拨克氏针固定、关节融合术或外固定支架等多种治疗方法。切开复位内固定作为目前跟骨骨折治疗的主流术式,治疗跟骨关节内骨折疗效满意,尤其是Sanders Ⅱ型和Ⅲ型骨折,但对于Ⅳ型骨折的治疗及是否植骨存在争议,其缺点是软组织并发症较高。跟骨骨折经皮微创撬拨复位内固定日益受到重视,但由于目前对跟骨骨折分类、撬拨复位适应证、固定方法、疗效评价标准等选择不一导致了临床疗效存在差异。跟骨骨折的治疗较为复杂,各种治疗方法均有其优点和不足,不能为追求解剖复位盲目扩大切开复位手术指征。根据患者损伤程度、骨折类型,合理选择适宜的治疗方案将有助于提高疗效。     

钛钢板内固定结合植骨治疗跟骨关节内骨折

跟骨骨折传统的闭合手法复位或斯氏针撬拨复位石膏外固定等方法,其治疗效果欠佳,常遗有疼痛、扁平足、足跟变宽等后遗症而严重影响患肢功能[1].笔者自2001年2月～2006年3月对45例(50足)跟骨骨折切开复位钛钢板内固定加自体髂骨植骨治疗,取得较好疗效.     

塑形钢板治疗距下关节内跟骨骨折43例疗效分析

目的 探讨塑形钢板治疗距下关节内跟骨骨折的临床效果。方法 采用开放复位塑形钢板内固定治疗距下关节内跟骨骨折共43例(46跟)。随访时间2．4年。进行手术前、后X线变化及临床结果评定。结果 全部病例术后可使跟骨距下关节疼痛消失，功能改善，跟距关节及跟骨恢复了正常的对合关系及形状。结论 塑形钢板内固定治疗距下关节内跟骨骨折是一种有效的疗法。     

跟骨解剖板治疗累及跟距关节的粉碎性跟骨骨折的临床研究

目的 研究应用特制跟骨解剖板治疗严重粉碎性跟骨骨折的临床应用价值。方法 自1999年1月～2001年8月，应用跟骨解剖板治疗严重粉碎的跟骨骨折14例，术前、术后采用静脉泵消除肿胀，配合抗真菌治疗。术中注意关节面、Bohlei角及临界角的复位，同时采用跟骨解剖板及松质骨螺钉进行牢固固定。结果 14例病人平均随诊23个月，病人主观症状满意率85．7％，足部外形优92．9％，足及踝关节活动优71．4％，Btihler角优78．6％。总体优良率98．3％。结论 跟骨解剖板治疗严重粉碎的跟骨骨折，固定牢固，允许术后早期功能练习，能最大限度的减少骨折后的并发症。     

Treatment of intraarticular calcaneal fractures in adults. A treatment algorithm

Summary Significant progress has been made in terms of the management of calcaneal fractures. This is reflected in the marked decrease in complication rates associated with the current intervention of these potentially devastating injuries. The treatment priorities that, in the authors opinion, are key to achieve best results in a displaced calcaneal fracture are anatomic reconstruction of the entire calcaneus: articular surfaces, height, alignment, and length, with a function directed postoperative management. The value of these priorities are confirmed by the authors longterm follow-up results as presented here. To reemphasize, conservative treatment should be considered only in cases of extraarticular fractures, minor displaced intraarticular fractures in nonambulatory patients, and in cases where there is a clear contraindication for surgery. Regarding the technical requirements for an anatomic reconstruction, the os calcis fracture should be categorized as a procedure for experts. In two-part fractures, according to the Sanders classification, an anatomical reduction is obtainable in more than 80 %–90 % of cases. However, in consideration of the articular cartilage damage, a 70 % rate of good to excellent clinical results seems realistic. In three-part fractures, anatomic reduction is attainable in about 60 % of cases with a 70 % rate of good results. These two subgroups comprise about 90 % of all calcaneus fractures. It is the authors recent experience to optimize the extended lateral approach using posteromedial and anterolateral windows, so that an anatomic reduction in more than 60 % of Sanders Type III os calcis fractures can be achieved. Further scientific work in this area of trauma orthopedics would benefit most from a general consensus on a fracture classification system and on a clinical scoring system, with 5 year follow-up studies using these treatment methods and evaluation systems.      

Association of Calcaneal and Spinal Fractures

Calcaneus fractures are common injuries that often lead to chronic pain and long-term disability. Appropriate initial management of calcaneal fractures involves assessment for concomitant trauma (polytrauma), and the vertebral column, in particular, the lumbar spine, is known to be especially vulnerable to simultaneous injury when the os calcis has been fractured. We undertook a retrospective cohort study that included 208 consecutive patients with data recorded in a radiographic database to determine the incidence of concomitant vertebral fracture in association with fracture of the calcaneus. A total of 15 calcaneal fractures (7.21%) were associated with concomitant vertebral fracture, and the lumbar spine was involved in 12 (80%) of these cases. The only clinical variable that was statistically significantly associated with the presence of concomitant calcaneal and vertebral fracture was localization of the vertebral fracture to the lumbar spine (p = .0001). The results of our investigation have indicated that the incidence of concomitant calcaneal and vertebral fractures was significantly lower clinically than the traditional 10% association described in previous studies.     

跟骨关节内骨折的治疗进展

跟骨关节内骨折是常见的足损伤。跟骨关节内骨折的治疗方式多种多样,可选择非手术治疗、切开复位加内固定等几种治疗方法。切开复位内固定治疗跟骨关节内骨折疗效满意。骨折治疗的关键是尽可能恢复跟距关节面的适应性和跟骨的正常解剖形态,围手术期的正确处理也非常重要。经过查阅国内外近年有关文献,并作综合分析,综述了跟骨关节内骨折的解剖、损伤的病因、治疗策略及有关的最新进展。     

切开复位固定＋不植骨治疗Sanders Ⅲ型和Ⅳ型跟骨骨折

目的探讨切开复位固定、不植骨治疗SandersⅢ、Ⅳ型跟骨骨折的手术方法及疗效。方法 2008年1月~2011年11月,应用跟骨外侧手术入路、切开复位解剖钢板固定、不植骨治疗跟骨粉碎性骨折66例、77足。其中男45例,女21例,11例为双侧。年龄22~55岁,平均37岁。根据Sanders分型,Ⅲ型17足,Ⅳ型60足。结果本组66例患者均获随访,获随访12~18个月,平均15个月。77足切口均Ⅰ期愈合,随访中无螺钉退出、断裂等现象。除5例合并股骨骨折的的病例,其余半年后均能正常行走。术前Bǒhler’s角（4.6°±6.2°）,术后（31.6°±7.4°）;术前Gissane’s角（158.12°±8.57°）,术后（136.58°±6.85°）,各指标手术前后比较差异有统计学意义。按Maryland足部评分系统评价术后功能,本组77足中,优（90~100分）68足,良（75~89分）8足。可（50~74分）1足,优良率98.7%。结论通过本方法治疗跟骨骨折,能够良好的维持跟骨的解剖形态,足的功能恢复满意,且明显降低了植骨术后的排异反应及切口不愈合的发生,有效的减轻了患者的痛苦和经济负担。     

跟骨骨折钢板内固定手术中存在的问题及对策

目的：回顾性分析跟骨骨折钢板内固定手术治疗中的操作及结果,找出存在的问题并提出相应的对策,以减少手术并发症的发生。方法：2008年6月至2009年4月收治156例患者,男121例,女35例;年龄18～59岁,平均41岁。32例双跟骨骨折,其中23例同时行双跟骨手术治疗,手术治疗跟骨共179足。对所有患者的手术记录予以分析,以便发现存在的问题及不足。结果：179个跟骨骨折中,有31足（17.3%）术后伤口出现问题：伤口感染不愈合26足（14.5%）,皮缘坏死5足（2.8%）,伤口不愈合。跟骨骨折钢板内固定手术存在许多问题,从手术设计到具体操作,以及骨折复位和固定。结论：手术的改良、微创操作、简单而有效的内固定是避免跟骨骨折手术并发症的惟一途径。     

Mechanism of articular fracture of the calcaneus in experimental, pathological, roentgenographic and computerized tomography examination]

The experiments on amputated extremities, pathological examination as well as plain and computerized radiology confirmed existence of two basic types of calcaneal articular fractures: tongue type and crush type. An accurate anatomy of the experimentally fractured os calcis could be restored only after Westhues. An articular surface in crush fracture could be restored only in open arthrotomy. Computerized tomography revealed the type of the fracture and the degree of calcaneal destruction very precisely but was of no practical value in the treatment of the os calcis fractures.     

Ultrasound Transmission Through the Os Calcis in Children: Which Side Should We Measure?

Ultrasound measurement of the os calcis is a promising technique when evaluating bone status. Large individual differences between the right and left calcaneus in adults were reported. In this study, calcaneal acoustic parameters in 373 healthy children and adolescents were investigated using a CUBAClinical bone densitometer. No significant difference was found between mean values on the right and left foot, however, individual difference in broadband ultrasound attenuation was 11 ± 9.25%. Individual differences between both sides in ultrasound investigation of the os calcis should not be underscored either in adults or in children. Received: 2 July 1996 / Accepted: 3 January 1997     

锁定钢板内置和外置治疗SandersⅡ型跟骨骨折的疗效及其有限元分析

目的比较锁定钢板内置和外置治疗SandersⅡ型跟骨骨折的临床疗效和生物力学差异。方法将64例行锁定钢板治疗的SandersⅡ型跟骨骨折患者按照钢板内置和外置分为对照组(钢板内置,30例)和观察组(钢板外置,34例)。比较两组切口长度、手术时间、术中出血量、拆线时间、住院费用、B?hler角、Gissane角、AOFAS踝-后足功能评分以及并发症发生率。建立SandersⅡ型跟骨骨折有限元模型,分别予以锁定钢板内置和外置装配,在相同加载条件下比较两种模型稳定性。结果患者均获得随访,时间6~24个月。①手术时间、术中出血量、拆线时间观察组均明显优于对照组(P<0.05)。切口长度、住院费用两组比较差异无统计学意义(P>0.05)。末次随访B?hler角、Gissane角两组比较差异无统计学意义(P>0.05)。末次随访AOFAS评分观察组高于对照组(P<0.05)。并发症发生率两组比较差异无统计学意义(P>0.05)。②有限元模型:对两种方法的跟骨内固定模型进行载荷施加后,骨折线分离移位均<1 mm,跟骨最大应力位于跟骨结节周围,内固定最大应力位于载距突螺钉部位,应力强度均位于安全范围内。结论锁定钢板外置治疗SandersⅡ型跟骨骨折安全、有效、稳定性可靠,为临床决策提供了新思路。