轴向跟距反牵器结合横向螺钉固定治疗关节内跟骨骨折

[目的] 探讨应用跟距反牵器轴向撑开结合螺钉横向固定治疗关节内跟骨骨折疗效。[方法] 对29例34足跟骨骨折采用跟距反牵器加螺钉固定治疗，术后进行综合评分。[结果] 本组29例34足优8足，良22足，可4足，优良率88．2％。[结论] 根据反牵器撑开结合螺钉固定治疗关节内蹋骨骨折创伤小，复位效果好，并发症少。     

空心螺钉内固定治疗跟骨骨折

正2016年1月～2018年4月,我科采用空心螺钉内固定治疗23例跟骨骨折患者,疗效满意,报道如下。1材料与方法1. 1病例资料本组23例,男16例,女7例,年龄18～55岁。骨折Sanders分型:Ⅱ型6例,Ⅲ型10例,Ⅳ型7例。致伤原因:高处坠落伤18例,扭伤5例。伤后至手术时间12～72 h。1. 2治疗方法腰麻下手术。患者健     

手术治疗关节内跟骨骨折

自1999年8月至2004年9月，笔采用切开复位跟骨钛钢板内同定治疗关节内跟骨骨折28例31足，疗效满意。现报告如下。     

应用跟骨钢板手术治疗跟骨关节内骨折

目的：探讨跟骨钢板内固定治疗跟骨关节内骨折的临床应用效果。方法：采用钢板内固定治疗跟骨关节内骨折13例，男10例，女3例；年龄26～50岁，平均38岁。按Sanders分型：Ⅱ型3例，Ⅲ型9例，Ⅳ型1例。对临床结果进行分析、总结。结果：术后随访时间4-22个月，平均16个月。术中无重要神经、肌腱损伤，术后无切口感染和深部感染，1例于骨折愈合后取内固定时发生切口小范围坏死；无骨不愈合和内固定松动及再骨折发生；1例于久走后出现距下关节痛，尚能忍受。按张铁良百分评分法进行评定：优6例，良6例，可1例，总优良率为92％。结论：跟骨钢板内固定治疗跟骨关节内骨折具有操作简单、有效恢复B6hler角和Gissane角、固定坚强、利于早期踝关节功能锻炼的优点，是目前治疗跟骨关节内骨折较为理想的方法之一。     

保守或简单手术治疗跟骨骨折的临床经验

目的 评价保守治疗或简单手术治疗跟骨骨折的疗效。方法 随访保守治疗或辅以经皮斯氏针撬拨、斯氏针固定、螺钉固定跟骨骨折2年以上的97例患者，管型石膏固定64例(保守组)；经皮斯氏针橇拨固定27例，螺钉固定6例(简单手术组)．结果 随访结果满意，其中优23例、良67例、可5例、差2例，优良率92．7％。2例在伤后1年左右因踝关节痛，行距跟关节融合术。结论 虽然保守治疗或简单手术治疗跟骨骨折疗效满意，但是临床需要有统一分型下的前瞻性对比研究，以进一步证明跟骨骨折是采用切开复位固定还是简单治疗。     

空心螺钉微创治疗跟骨骨折疗效分析

目的探讨空心螺钉微创治疗跟骨骨折的效果。方法44例SandersⅡ、Ⅲ、Ⅳ型跟骨骨折患者在C臂X线机透视下,用微创的方法经皮克氏针撬拨复位或加用外侧小切口直视下复位,空心螺钉内固定治疗。结果44例均获随访,时间6～20（12±2.3）个月。按Maryland足部评分系统评定功能：优33例,良8例,差3例,优良率93.2%。结论空心螺钉微创治疗跟骨骨折疗效满意。     

跟骨骨折的手术治疗

2001年3月～2004年10月,笔者采用手术治疗跟骨关节内骨折36例,效果较满意.现报告如下.     

闭合复位经皮螺钉内固定治疗跟骨骨折

目的探讨闭合复位经皮螺钉内固定治疗跟骨骨折的适应证及优、缺点。方法采用闭合复位经皮螺钉内固定治疗34例跟骨骨折患者。末次随访时采用AOFAS踝-后足评分系统评价疗效。结果患者均获得随访,时间12～38个月。骨折愈合时间8～12周。末次随访时,B9hler角从术前15. 4°±4. 1°改善至26. 4°±4. 9°; Gissane角从术前94. 2°±7. 9°改善至118. 7°±6. 6°; AOFAS踝-后足评分为78～94 (86. 0±5. 1)分,其中优19例,良12例,可3例,优良率为91. 2%。至末次随访时,未发现创伤性关节炎征象,无明显跛行。结论闭合复位经皮螺钉固定治疗跟骨骨折复位满意,可减少手术损伤和术后并发症,缩短治疗时间,安全、可靠。     

跟骨钢板治疗跟骨经关节内骨折17例体会

自2002年10月至2005年10月,我们采用跟骨钢板治疗17例18侧跟骨经关节内移位骨折,疗效满意。报道如下。临床资料1.一般资料:本组17例18足,男13例,女4例。年龄20~52岁,平均37岁。均为高处坠落伤。骨折类型为波及跟距关节面的跟骨骨折。所有病例均行跟骨侧轴位X线检查和CT扫描。根据Sanders分型:Ⅱ型7侧,Ⅲ型9侧,IV型2侧。手术时机为伤后5h~11d,平均4d。2.手术方法:上止血带,取侧卧位,行跟骨外侧“L”型切口。全层至骨膜下紧贴跟骨外侧壁锐性剥离,推移,将包括腓骨肌腱、腓肠神经在内的全层软组织瓣一并掀起,暴露至跟距关节及跟骰关节。将跟…     

跟骨钛钢板内固定治疗移位跟骨关节内骨折的临床疗效

目的探讨跟骨钛钢板内固定在治疗移位跟骨关节内骨折临床疗效。方法自2006年1月。2009年4月．对28例30足移位跟骨关节内骨折采用跟骨外侧扩大“L”形切口,切开复位跟骨钛钢板内固定。根据骨缺损情况,必要时配合自体髂骨植骨。术后不需要石膏外固定。结果所有患者均获得6月～46月随访（平均为18．5月）。骨折全部愈合,平均愈合时间14．5周（12周～18周）。患者手术前Bohler＇s角平均为9．7。,术后半年为34．5°;Gissane’s角平均为103．2°。术后半年平均为132．50。按Maryland足部评分标准：优22足,良4足,可4足,优良率86．7％。结论跟骨解剖型钛钢板固定可靠,是治疗移位跟骨关节内骨折的理想方法。     

开放性跟骨骨折的诊治

开放性跟骨骨折是一种少见的损伤,但所造成的后果可以是灾难性的。即使治疗方案正确,这些高能量损伤的疗效常常也不能令人满意。早期治疗包括多次冲洗清创、抗生素治疗和骨折稳定。二期治疗的重点在于骨软骨损伤的治疗,适当且及时的治疗是取得满意疗效、减少并发症的关键。     

跟骨插入式钢板的研制及其在跟骨关节内移位性骨折手术中的应用

目的 研制一种适合于经跗骨窦切口经皮插入式的跟骨微创钢板,探讨其在移位性跟骨关节内骨折治疗中的疗效. 方法 自2006年9月至2008年9月经跗骨窦切口入路,采用跟骨经皮插入式钢板治疗跟骨关节内骨折38例(40足),其中SandersⅡ型22足(Ⅱa型6足,Ⅱb型14足,Ⅱc型2足),Ⅲ型18足(Ⅲab型7足,Ⅲac型10足,Ⅲbc型1足).根据X线片对手术前后跟骨高度、宽度、长度及跟骨Bohlers角和Gissanes角进行比较分析,并观察术后切口愈合情况.采用Maryland足部评分系统评价临床功能疗效. 结果 所有患者术后获得3～24个月(平均12个月)随访,X线片示术后跟骨高度、宽度、长度及跟骨Bohlers角和Gissanes角均获得满意矫正,与术前比较,差异均有统计学意义(P<0.01).Maryland足部评分系统显示:优32足,良6足,可2足,优良率95.0%.术后未发现明显并发症. 结论 采用经跗骨窦切口跟骨插入式钢板治疗跟骨关节内移位性骨折不仅可以获得满意的疗效,而且能够有效避免术后并发症的发生.     

Surgical treatment of intra-articular calcaneal fractures: description of a technique using an adjustable uniplanar external fixator

Several surgical techniques are available for the treatment of intra-articular calcaneal fractures. The use of a uniplanar external fixator is an option for the treatment of fractures classified as Sanders types 2 and 3. Satisfactory reduction and stabilisation of the fracture are achieved by means of mini-incisions and fixator adjustment. The advantages of this technique include less soft-tissue damage, avoidance of internal implants and early weight-bearing with the potential to improve postoperative recovery.     

Complications following the extended lateral approach for calcaneal fractures do not influence mid- to long-term outcome

Background and aim

Open reduction and internal fixation (ORIF) of intra-articular calcaneal fractures through an extended lateral approach is frequently accompanied by a high complication rate. However, ORIF currently provides the best long-term clinical results. The aim of this study was twofold: (1) to evaluate both mid- to long-term clinical and radiological results of a consecutive series treated by ORIF and (2) to determine the influence of short-term complications on long-term clinical outcome.

Methods

Patients with a displaced intra-articular calcaneal fracture, treated with ORIF, through an extended lateral approach, in a level-2 trauma centre between 1995 and 2008 were evaluated for the study. The long-term functional outcome (American Orthopaedic Foot & Ankle Society (AOFAS), 36-Item Short-Form Health Survey (SF-36) and Visual Analogue Scale (VAS)) and radiographic results (e.g., Böhler and Gissane angle, height, width and joint reduction) were determined. Short- and long-term complications were documented.

Results

A total of 57 patients matched the inclusion criteria, from which 39 patients agreed to participate in this study (68%). The median follow-up was 6.5 years (range 2–16 years). Based on the AOFAS hindfoot score, 74% of the patients had a good-to-excellent long-term clinical result. Radiological results were satisfying with a median postoperative Böhler angle of 26° and 25° at follow-up. Complications occurred in 32% of all patients; mainly wound-healing problems were noted. Short-term complications did not influence mid- to long-term clinical results (p > 0.05). Anatomic reconstruction of the calcaneus was associated with improved long-term clinical results (p < 0.05).

Conclusion

Despite the high complication rate following ORIF of a calcaneal fracture, complications do not affect mid- to long-term clinical outcome. Surgical treatment should focus on restoring the anatomy.Level of evidence: Therapeutic level IV.     

Complication rates following operative treatment of calcaneus fractures

Background

The purpose of this study is to report the short-term complication rates and mid-term subtalar fusion rates following operative management of calcaneal fractures.

Methods

This is a retrospective study of Californians undergoing operative treatment of a calaneus fracture from 1995 to 2005. The main outcomes reported are readmission for a short-term complication within 90 days of surgery and reoperation for subtalar fusion during the observation period.

Results

We identified 4481 patients who underwent open reduction and internal fixation of their fracture as inpatients within 30 days of the index admission. The short-term rate of complications included a 90-day rate of readmission of 1.03% for wound infection, 0.25% for thromboembolic disease, and 0.22% for mortality. The mid-term rate of subtalar fusion was 3.49% at 5 years post-operatively.

Conclusions

This study reports the short-term complication rates and mid-term subtalar fusion rates following operative management of calcaneal fractures using population-based data.     

跟骨关节内骨折畸形愈合的手术治疗

目的探讨跟骨关节内骨折畸形愈合手术治疗方法及各种方法的优、缺点。方法2002年6月至2004年3月，手术治疗跟骨关节内骨折畸形愈合28例30足，男26例28足，女2例2足；年龄23-59岁，平均39．2岁；左侧15例，右侧11例，双侧2例。受伤距手术治疗时间为2-5个月，平均3-3个月。行切开复位内固定术13例14足，行保留距下关节的跟骨截骨矫形术9例10足，行跟骨丘部重建距下关节融合术6例6足。结果28例30足中，29足皮肤切口一期愈合；1足伤口感染，经恒定负压吸引、换药后愈合。随访时间10-29个月，平均15．6个月，无一例发生截骨、关节融合植骨不愈合。平均愈合时间为2．5个月，完全负重时间为3个月。分别在手术前、后跟骨侧位及轴位X线片和CT片上测量Boehler角、Gissane角、跟骨的宽度及轴长、跟骨体一丘部高度并进行比较，手术前、后各指标相比差异均有统计学意义（均P〈0．01）。按美国足踝外科协会Maryland足评分系统评价手术前、后的功能：术前，可9足、差21足；术后，优7足、良19足、可3足、差1足；优良率为86．7％。Maryland评分术前为32分。术后为83分，平均改善51分。结论手术治疗跟骨关节内骨折畸形愈合时，应根据其病理特点，合理地选择手术方法。     

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.