Zwipp分型与跟骨骨折区块化固定的临床意义

目的：探索根据Zwipp分型及Sanders分型对跟骨骨折块区块化固定的临床价值。方法：共纳入58例患者,其中男35例,女23例;年龄26～54岁,平均48.5岁。其中双侧骨折4例,共手术62足。合并跟骰关节骨折11例。SandersⅡ型17足,Ⅲ型38足,Ⅳ型7足。按Zwipp分型,4部分＋1关节14足,4部分＋2关节19足,5部分＋2关节29足。均行切开复位钛钢板内固定加植骨术,将跟骨骨折块分为5大区块,以外侧钢板为中心,每一区块保证至少2枚螺钉固定。结果：所有病例均获随访,随访时间12～35个月,平均22.1个月。术前Bhler’s角平均为-12.05°,Gissane’s角平均为93.12°。术后Bhler＇s角平均为29.35°,Gissane’s角平均为124.26°。术前与术后比较差异有统计学意义（P〈0.05）。Maryland足部功能评分优30例,良19例。AOFAS评分优31例,良14例。结论：结合Zwipp分型及Sanders分型,将跟骨骨折块区块化,从而指导螺钉的固定方式,手术效果良好,具有一定的临床指导价值。

The clinical value of fixing calcaneal fractures by blocks according to Zwipp classification

Objective：To explore the clinical value of fixing the calcaneal fractures by blocks according to Zwipp classification and Sanders classification.Methods：58 cases,35 males and 23 females;aged 26~54 years,mean 48.5 years old.Bilateral fractures in 4 cases,a total of 62 foot sustained surgery.There were calcaneocuboid joint fractures in 11 cases.17 foot was Sanders typeⅡ,38 foot type Ⅲ,7 foot type Ⅳ.According Zwipp classification systerm,14 foot were 4 part and 1 joint type,19 foot were 4 part and 2 joint type,29 foot were 5 part and 2 joint type.All cases underwent open reduction and internal fixation with titanium plate and bone graft surgery,the fractures were divided into five large blocks,each block was fixed by at least two screws as the center of the outer steel plate.Results：All patients were followed up for 12~35 months,an average of 22.1 months.The average preoperative Bhler＇s angle is-12.05 °,Gissane＇s angle average of 93.12 °.The average postoperative Bhler＇s angle was 29.35 °,Gissane＇s angle average of 124.26 °.There was significant different（P0.05） before and after operation.Maryland foot function score There were excellent in 30 cases,good in 19 cases according to Maryland foot function score system;excellent in 31 cases,good in 14 cases according to AOFAS score system.Conclusion：The blocking the calcaneal fractures by combination of Zwipp classification and Sanders classification could guide screw fixation methods,resulted in excellent treatment and had some clinical guidance value.