开窗直视下联合复位内固定治疗跟骨骨折

目的探讨跟骨外侧开窗直视下联合复位钢板内固定治疗跟骨骨折的临床疗效。方法对36例(38足)SandersⅡ~Ⅳ型跟骨骨折患者采用跟骨外侧切口,在跟骨外侧皮质开窗后直视下复位塌陷的关节面,尽量恢复Gissane角、Bhler角;对有骨缺损者行自体髂骨及异体骨植骨后钢板内固定。术后X线片上测量Bhler角、Gissane角及跟骨的长度、宽度、高度,与术前进行比较。按照Maryland足功能评分系统对患者术后功能进行评定。结果 31例患者(32足)获得随访,失访5例(6足),随访时间12~24个月。术后1年X线片示骨折处均达到骨性愈合。Bhler角:术前-3.6°±5.8°、术后29.4°±4.0°,差异有统计学意义(P0.05);Gissane角:术前88.9°±6.3°、术后115.9°±5.6°,差异有统计学意义(P0.05)。术后跟骨长度、宽度及结节部高度与术前比较差异均有统计学意义(P0.05)。采用Maryland足功能评分标准评估术后功能:优11足,良13足,可5足,差3足。结论跟骨外侧开窗直视下联合复位内固定治疗跟骨SandersⅡ、Ⅲ型骨折疗效满意,SandersⅣ型骨折疗效尚可。

Open window for reduction and plate fixation under direct vision to treat the calcaneal frac-tures

Objective To investigate the clinical efficacy of opening window from lateral calcaneous under direct vision followed by reduction and internal fixation to treat the calcaneal fractures. Methods 36 cases （38 feet） of Sanders Ⅱ-Ⅳ types of calcaneal fractures were treated by using the method of opening window from lateral calcaneous for reduction of collapse of articular surface and restoring the Gissane angle, Bohler angle under the direct vision as far as possible, and internal fixation after bone graft in the bone defect place. X-ray Bohler angle, Gissane angle and the length, width, height of calcaneal bone after operation were measured and compared with preoperative. According to the Maryland-foot score, the curative effect was assessed for postoperative function. Results 31 patients（32 feet） were followed up for 12 - 24 months ,5 cases （6 feet） were lost. X-ray indicated all patients achieved bone healing after one year. Preoperative B6hler angle was -3.6° ± 5.8°, and postoperative was 29.4° ±4.0°, there was statistical significance（P 〈0. 05） ;preoperative angle of Gissane was 88.9° ±6.3° ,postoperative was 115.9° ±5.6°, there was statistical significance （ P 〈 0.05 ） ; the length, width and height of calcaneal bone between preoperative and postoperative, there was statistical significance （P 〈 0. 05 ）. The Maryland-foot score system for postoperative function was excellent in 11 feet, good in 13, fair in 5, and poor in 3. Conclusions Open window for reduction and plate fixation under direct vision for sanders type Ⅱ , Ⅲ fracture curative effect is satisfied and for type IV fracture is good.