切开复位内固定治疗Sanders Ⅲ型及Ⅳ型跟骨骨折

目的：探讨切开复位内固定治疗Sanders Ⅲ、Ⅳ型跟骨骨折的手术方法和治疗效果。方法：2004年1月至2010年1月,采用切开复位内固定术治疗51例58足Sanders Ⅲ、Ⅳ型跟骨骨折,男29例,女22例;年龄17～58岁,平均29.5岁;伤后至手术时间7～14d,平均10d。术前均行CT扫描及三维重建,按Sanders分类：Ⅲ型26足,Ⅳ型32足。均经可延长的外侧＂L＂形入路切开复位钢板内固定治疗。术后通过X线测量B觟hler角、Gissane角并与术前进行比较,按照Maryland足部评分系统从疼痛、功能方面对疗效评定。结果：51例58足全部获随访,时间6～24个月,平均13个月。术后皮缘表皮坏死2足,慢性疼痛4足,晚期发生距下关节炎2足,并发症发生率13.8%（8/58）。按照Maryland足部评分系统：优23足,良27足,可5足,差3足。结论：切开复位钢板内固定治疗Sanders Ⅲ、Ⅳ型跟骨骨折,能够获得较满意的解剖复位,且固定可靠,是治疗Sanders Ⅲ、Ⅳ型跟骨骨折的有效方法。

Treatment of Sanders type III and IV calcaneal fractures with open reduction and internal fixation

Objective：To investigate the surgical techniques and results of open reduction and internal fixation for the treatment of Sanders type Ⅲ,Ⅳ calcaneal fractures.Methods：From January 2004 to January 2010,58 feet of Sanders type Ⅲ,Ⅳ in 51 patients were treated with open reduction and plate fixation through L incision.There were 29 males and 22 females,the age ranged from 17 to 58 years with an average of 29.5 years old.The time between injury and operation ranged from 7 to 14 days（mean,10 days）.All the patients underwent systematic CT scan with coronal and horizontal images and sagittal reconstruction.The classification of the fractures by the Sanders scale showed that there were 26 feet of type Ⅲ,32 feet of type Ⅳ.The B？觟hler angle and Gissane angle were compared before and after operation.The clinical results were evaluated with the Maryland foot score：pain（45 scores）,function（55 scores：distance walked 10 scores,stability 4,support 4,limp 4,shoes 10,stairs 4,terrain 4,cosmesis 10,motion 5）.Results：All 58 feet in 51 patients were followed up,and the duration ranged from 6 to 24 months,with an average of 13 months.The incidence of complications was 13.8%（8/58）.Incision superficial necrosis in 2 feet,choronicity pain in 4 feet,subtalar joint arthrositis of advanced stage in 2 feet.According to Maryland foot score,the results were excellent in 23 feet,good in 27,fair in 5,poor in 3.Conclusion：The surgical techniques and results of internal fixation to fractures are related to anatomic features of calcaneus and their injury mechanism.It is an effective method for the treatment of calcaneal fractures with Sanders type Ⅲ,Ⅳ.